Claim Representative, Medical Only

Overview

Position Title: Claim Representative, Medical Only

Location: Reading, MA

Schedule: 8:00 am- 4:00 pm ET

Salary Range: $20/hr-$24/hr

 

Build Your Career With Purpose at CCMSI

 

At 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.

 

 

The 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 direct supervision.
• Review and approve related medical and miscellaneous invoices on designated claims. Negotiate any disputed bills/invoices for resolution under direct supervision.
• Request and monitor medical treatment of designated claims in accordance with corporate claim standards.
• 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.
• Provide support to claim staff on client service teams.
• Compliance with Corporate Claim Standards and special client handling instructions as established.

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.

 

Education and/or Experience   

Associate Degree or two (2) year's related business experience preferred.

Knowledge of medical terminology preferred. 

 

Nice to Have:

Bilingual (Spanish) proficiency — highly valued for communicating with claimants, employers, or vendors, but not required.

                                                           

Computer Skills   

Proficient using Microsoft Office products such as Word, Excel, Outlook                               

 

Certificates, Licenses, Registrations

Adjusters license may be required based upon jurisdiction.

 

Why 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 environment

 

How We Measure Success 

 

 At 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 & Compliance

 

The posted salary reflects CCMSI’s good-faith estimate in accordance with applicable pay transparency laws. Actual compensation will be based on qual