Claim Representative, Medical Only SeniorLocation: Phoenix, AZSchedule: 8:00am - 4:30pm (MST) Hybrid schedule after initial training period (one day a week in-office)Salary Range: $50,000 - $65,000 (depending on experience, paid out hourly)Build Your Career With Purpose at CCMSIAt CCMSI, we partner with global clients to solve their most complex risk management challenges, delivering measurable results through advanced technology, collaborative problem-solving, and an unwavering commitment to their success. We don't just process claims—we support people. As the largest privately-owned Third Party Administrator (TPA), CCMSI delivers customized claim solutions that help our clients protect their employees, assets, and reputations. We are a certified Great Place to Work®, and our employee-owners are empowered to grow, collaborate, and make meaningful contributions every day.Job SummaryManages designated medical-only claims and provides support to claims staff. Serves as a developmental role with potential advancement to an intermediate claims position. Responsible for delivering high-quality claim service in alignment with CCMSI client expectations and corporate claim standards.ResponsibilitiesWhen we hire claim reps at CCMSI, we look for detail oriented professionals who understand that every task supports a real person's claim experience, value accuracy and responsiveness, and contribute to the team's success through organization, collaboration, and a strong commitment to service.Manage and administer designated medical-only claims in compliance with corporate claim standards and applicable lawsEstablish and maintain appropriate reserves within authority limits or provide reserve recommendationsReview, approve, and negotiate medical and related invoices to ensure accurate and timely payment resolutionSet up new claim files and ensure all required documentation and system entries are completed accuratelyMaintain claim activity through detailed diary management and timely follow-upCoordinate, request, and monitor medical treatment in accordance with established guidelinesRespond promptly to provider and stakeholder inquiries, including return phone callsDocument and summarize correspondence, medical records, and claim activity in file notes and maintain organized claim filesClose claims appropriately and assist with file retrieval and storage as neededDeliver high-quality claim service aligned with client expectations and corporate standardsAdhere to all corporate claim procedures and specialized client handling instructionsSupport client service teams and contribute to overall client satisfactionProvide support and technical guidance to claim staffAssist with claim audits and quality reviews for Medical Only I and II adjustersTrain and mentor newly hired or promoted adjustersPartner with team members to develop and implement performance improvement plans as neededHandle more complex claims, including national accounts, as assignedManage claims across multiple jurisdictions when requiredParticipate in special projects and conduct in-depth research as requestedExercise technical oversight of designated claim filesWork independently with minimal supervision while maintaining high performance standardsQualificationsRequired:Strong oral and written communication skillsArizona Adjuster LicenseICA Arizona Adjuster Authorization5 or more years handling medical only claimsSelf-motivated with the ability to work independently and take initiativeExcellent organizational, coordination, and prioritization skillsAbility to operate general office equipment and perform clerical tasksDemonstrated flexibility and adaptability in a fast-paced, changing environmentAbility to work effectively with minimal direct supervisionHigh level of discretion with the ability to maintain confidentialityStrong teamwork and collaboration skillsReliable and consistent attendance within designated client service hoursCommitment to delivering responsive, high-quality service to internal and external clientsAbility to communicate clearly and professionally, both verbally and in writing, with all stakeholdersNice to Have:Bilingual (Spanish) proficiency - highly valued for communicating with claimants, employers, or vendors.Experience supporting municipal accounts is a plusKnowledge of medical terminologyPrior experience in a claims or medicalWhy You'll Love Working Here• 4 weeks (Paid time off that accrues throughout the year in accordance with company policy) + 10 paid holidays in your first year • Comprehensive benefits: Medical, Dental, Vision, Life, and Disability Insurance • Retirement plans: 401(k) and Employee Stock Ownership Plan (ESOP) • Career growth: Internal training and advancement opportunities • Culture: A supportive, team-based work environmentHow We Measure SuccessAt CCMSI, great adjusters stand out through ownership, accuracy, and impact. We measure success by:• Quality claim handling – thorough investigations, strong documentation, well-supported decisions • Compliance & audit performance – adherence to jurisdictional and client standards • Timeliness & accuracy – purposeful file movement and dependable execution • Client partnership – proactive communication and strong follow-through • Professional judgment – owning outcomes and solving problems with integrity • Cultural alignment – believing every claim represents a real person and acting accordingly This is where we shine, and we hire adjusters who want to shine with us.Compensation & ComplianceThe posted salary reflects CCMSI's good-faith estimate in accordance with applicable pay transparency laws. Actual compensation will be based on qualifications, experience, geographic location, and internal equity. This role may also qualify for bonuses or additional forms of pay. CCMSI offers comprehensive benefits including medical, dental, vision, life, and disability insurance. Paid time off accrues throughout the year in accordance with company policy, with paid holidays and eligibility for retirement programs in accordance with plan documents. Visa Sponsorship: CCMSI does not provide visa sponsorship for this position. ADA Accommodations: CCMSI is committed to providing reasonable accommodations throughout the application and hiring process.
Equal Opportunity Employer: CCMSI complies with all applicable employment laws, including pay transparency and fair chance hiring regulations. Background checks, if required for the role, are conducted only after a conditional offer and in accordance with applicable fair chance hiring laws.Our Core ValuesAt CCMSI, we believe in doing what's right—for our clients, our coworkers, and ourselves. We look for team members who:Lead with transparency We build trust by being open and listening intently in every interaction.Perform with integrity We choose the right path, even when it is hard.Chase excellence We set the bar high and measure our success. What gets measured gets done.Own the outcome Every employee is an owner, treating every claim, every decision, and every result as our own.Win together Our greatest victories come when our clients succeed.We don't just work together—we grow together. If that sounds like your kind of workplace, we'd love to meet you.