Claim Representative, Medical Only

Overview

Claim Representative, Medical Only 

Location: Houston, Texas 

Schedule: 8:00 am - 4:30pm (CST) - Hybrid Schedule after initial training period (2 days in- office per week)

Salary Range: $20-24/hour

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.

 

Job Summary 

 

Manages designated medical-only claims and supports claims staff, with opportunity for development and promotion to Medical Only Claim Representative II or Claim Associate I. Accountable for delivering quality claim services that meet CCMSI corporate standards and client expectations.

 

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.
• Performs other duties as assigned.

Qualifications

Required:

• Associate degree OR two (2) years of related business experience
• Ability to manage medical‑only claims cradle‑to‑grave
• Active Texas Adjuster License 
• Strong attention to detail and organization skills
• Ability to follow established procedures and meet deadlines
• Proficiency with Microsoft Office (Word, Excel, Outlook)
• Strong written and verbal communication skills
• Reliable, predictable attendance during scheduled hours
• Ability to work in a fast‑paced, in‑office environment

Nice to Have: 

• Prior medical‑only or workers’ compensation claims experience
• Knowledge of medical terminology
• Experience working with multiple clients or industries
• Prior experience in a TPA environment
• Bilingual (Spanish) Proficiency- Highly valued for communicating with claimant, employers, or vendors. Not required. 

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, medical‑only claim professionals succeed through accuracy and consistency. Success in this role is measured by:

• Queue management – timely handling of assigned medical‑only claims• Audit performance – compliance with corporate standards and NM regulations• Accuracy & documentation – clear, complete, and timely claim notes• File progression – appropriate reserve activity and timely claim closure• Team support & reliability – responsiveness and dependable in‑office attendance• Cultural alignment – recognizing that every claim represents a real person

 

This is where we shine, and we hire claim professionals 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 qualifications, experience, geographic location, and internal equity. This ro