Medical Only Claim Representative I

Overview

Claim Representative – Medical Only

Location: Albuquerque, NM (In‑Office)

Schedule: Monday–Friday, 8:00 AM – 4:30 PM (37.5 hours per week)

Salary Range: $20.00 per 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

The Medical Only Claim Representative is responsible for managing medical‑only workers’ compensation claims from start to finish for a multiple‑client desk spanning various industries within the New Mexico jurisdiction. This role focuses on quality medical management, accurate documentation, and compliance with CCMSI standards and client handling instructions.

 

This is an in‑office position in Albuquerque, NM, with a potential opportunity for a hybrid schedule in the future based on performance and business needs. This role may also serve as a training and development position for advancement into higher‑level claim roles.

 

Responsibilities

• Set up and manage medical‑only workers’ compensation claim files in accordance with corporate standards and New Mexico regulations
• Review incoming medical documentation and summarize correspondence and records in claim notes

• Establish initial reserves and provide reserve recommendations under direct supervision

• Review, approve, and process medical and miscellaneous invoices related to designated claims

• Assist with bill negotiations or dispute resolution under guidance

• Coordinate and monitor medical treatment to ensure timely and appropriate care

• Maintain accurate, timely, and well‑documented electronic claim files

• Close claim files when appropriate and retrieve closed files as needed

• Support claim staff and client service teams with medical‑only claim activity
• Maintain compliance with corporate claim handling standards and client‑specific instructions

Qualifications

 

Required:

• Associate degree OR two (2) years of related business experience
• Ability to manage medical‑only claims cradle‑to‑grave
• Active New Mexico Adjuster License OR ability to obtain within 60 days of hire
• 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 claimants, employers, or vendors, but 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 dep