CCMSI Hiring for Claim Assistant Job at Houston, TX Full Time

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  Culture: Our Core Values are embedded into our culture of how we treat our employees as a valued partner-with integrity, passion and enthusiasm.
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  Career development: CCMSI offers robust internships and internal training programs for advancement within our organization.
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  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.
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  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.

Responsibilities:

• Investigate, evaluate and adjust contested medical-only claims and handle indemnity claims under direct supervision.
• Establish reserves and/or provide reserve recommendations within established authority levels under direct supervision.
• Set up designated claim files and complete all set up instructions, as requested.
• Set up independent medical exams as deemed necessary under direct supervision.
• Request and monitor medical treatment of designated claims in accordance with corporate claim standards.
• Review and approve related medical, legal, damage estimates and miscellaneous invoices on designated claims. Negotiate any disputed bills/invoices for resolution under direct supervision.
• Negotiate settlements in accordance within Corporate Claim Standards, client specific handling instructions and state laws under direct supervision, when appropriate.
• As appropriate, make referrals to outside vendors on designated cases under direct supervision. (i.e. legal, surveillance, case management, etc.)
• Effective and timely coordination of communication with clients, claimants and other appropriate parties throughout the claim adjustment process.
• Authorize and make payments on claims utilizing a claim payment program in accordance with industry standards and within established authority levels under direct supervision.
• Compute disability rates in accordance with state laws under direct supervision, when appropriate.
• Summarize all correspondence and medical records in claim log notes as well as file same in the appropriate claim.
• Return provider calls.
• Review and maintain personal diary on claim system.
• Provide technical and clerical claims support to designated clients, as requested.
• Compliance with corporate claim standards and special client handling instructions as established.
• Other duties, as assigned.

Qualifications:

• 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.