Claim Representative, Medical Only Senior - Louisville Kentucky

Company: Ccmsi
Location: Louisville, Kentucky
Posted On: 05/03/2024

Overview:At CCMSI, we look for the best and brightest talent to join our team of professionals. As a leading Third Party Administrator in self-insurance services, we are united by a common purpose of delivering exceptional service to our clients. As an Employee-Owned Company, we focus on developing our staff through structured career development programs, rewarding and recognizing individual and team efforts. Certified as a Great Place To Work, our employee satisfaction and retention ranks in the 95th percentile.Reasons you should consider a career with CCMSI:Culture: Our Core Values are embedded into our culture of how we treat our employees as a valued partner-with integrity, passion and enthusiasm.Career development: CCMSI offers robust internships and internal training programs for advancement within our organization.Benefits: Not only do our benefits include 4 weeks paid time off in your first year, plus 10 paid holidays, but they also include Medical, Dental, Vision, Life Insurance, Critical Illness, Short and Long Term Disability, 401K, and ESOP.Work Environment: We believe in providing an environment where employees enjoy coming to work every day, are provided the resources needed to perform their job and claims staff are assigned manageable caseloads.The Senior Medical Only Claim Representative is responsible for claims handling of designated medical only claims and provide support to claim staff. This position may be used as a training position for consideration of promotion to an intermediate level claim position. Is accountable for the quality of claim services as perceived by CCMSI clients and within the corporate claim standards.Responsibilities:Set up and manage medical files only in accordance with corporate claim standards and law.Establish reserves and/or provide reserve recommendations within established authority levels under minimal supervision.Review and approve related medical and miscellaneous invoices on designated claims. Negotiate any disputed bills/invoices for resolution under minimal supervision.Set up designated claims files and complete all set up instructions, as requested.Review and maintain personal diary on claim system.Request and monitor medical treatment of designated claims in accordance with corporate claim standards.Return provider phone calls.Summarize all correspondence and medical records in claim log notes as well as file same in the appropriate claim.Close claim files when appropriate.Retrieve closed claim files and re-file in storage, as requested.Delivery of quality claim service to clients.Client SatisfactionProvide support to claim staff on client service teams.Compliance with Corporate Claim Standards and special client handling instructions as established.May be required to handle more sophisticated or national accounts with more stringent claim handling service instructions.May be required to handle multiple jurisdictions within caseload.Perform/assist with claim audits for Medical Only I and II adjusters as needed.Train newly hired/promoted Medical Only adjusters.Work with Medical Only I and II adjusters as needed to develop an action plan(s) to achieve any necessary improvement.Special projects and in depth research as requested.Technical supervision of designated claim files.Work with minimal supervision and direction.Qualifications:To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge, skills, and/or abilities required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.Excellent oral and written communication skills.Individual must be a self-starter with strong organizational abilities.Ability to coordinate and prioritize required.Ability to operate general office equipment and perform clerical duties.Flexibility, initiative, and the ability to work with a minimum of direct supervision a must.Discretion and confidentiality required.Ability to work as a team member in a rapidly changing environment.Reliable, predictable attendance within client service hours for the performance of this position.Responsive to internal and external client needs.Ability to clearly communicate verbally and/or in writing both internally and externally.Education and/or ExperienceAssociates degree or two years related business experience required.Knowledge of medical terminology preferred.Computer SkillsProficient with Microsoft Office programs.Certificates, Licenses, RegistrationsAdjusters license may be required based upon jurisdion.Physical DemandsThe physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.Object Handling CategoriesWork requires the ability to lift/carry objects routinely as follows: Light Lifting: No lifting of objects weighing more than 15 pounds on a regular basis.Other Physical DemandsWork requires the ability to sit or stand up to 7.5 or more hours at a time.Work requires sufficient auditory and visual acuity to interact with others.CORE VALUES & PRINCIPLESResponsible for upholding the CCMSI Core Values & Principles which include: performing with integrity; passionately focus on client service; embracing a client-centered vision; maintaining contagious enthusiasm for our clients; searching for the best ideas; looking upon change as an opportunity; insisting upon excellence; creating an atmosphere of excitement, informality and trust; focusing on the situation, issue, or behavior, not the person; maintaining the self-confidence and self-esteem of others; maintaining constructive relationships; taking the initiative to make things better; and leading by example.CCMSI is an Affirmative Action / Equal Employment Opportunity employer offering an excellent benefit package including Medical, Dental, Prescription Drug, Vision, Flexible Spending, Life, ESOP and 401K.by Jobble More...

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