Insurance Claims Assistant - Workers' Compensation - In Office (Irvine, CA) - Irvine - ref. u95977819

Overview:

Join CCMSI as a Claim Assistant - Onsite Position in Irvine, CA

Location: In-office role

As an Employee-Owned Company, CCMSI invests in your career growth, offers robust benefits, and fosters a culture that celebrates integrity, passion, and enthusiasm.

Key Responsibilities:

• Assist 4-5 examiners with administrative tasks, including benefit notices, serving records, fax retrieval, mail handling, and phone support.
• Coordinate various clerical duties and manage general office equipment.
• Provide responsive service to both internal and external clients.

Required Skills:

• Strong multi-tasking abilities and a proactive, self-starter attitude.
• Excellent communication skills (oral and written) and exceptional typing proficiency.
• Ability to prioritize and handle rush assignments with flexibility.
• Collaborative team player with a commitment to confidentiality and discretion.

Preferred Qualifications:

• Knowledge of medical terminology.
• Prior experience in a fast-paced, client-focused environment.

• Culture: Join an employee-centric workplace where our core values—integrity, passion, and enthusiasm—are the foundation of our success.
• Career Development: Enjoy opportunities for growth through structured training and development programs.
• Competitive Benefits: Start with 4 weeks of paid time off, plus 10 paid holidays, Medical, Dental, Vision, Life Insurance, Short & Long-Term Disability, 401K, and Employee Stock Ownership Plan (ESOP).

CCMSI is certified as a Great Place to Work, with employee satisfaction and retention in the 95th percentile. Here, you’ll find an environment that’s committed to your success, where your contributions make a difference every day.

Apply today and become a valued member of our team!

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:

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. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

• 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.

Education and/or Experience

Associate’s degree or two year’s related business experience.

Knowledge of medical terminology preferred.

Computer Skills

Proficient with Microsoft Office programs.

Certificates, Licenses, Registrations

none required.

CORE VALUES & PRINCIPLES

Responsible for upholding the CCMSI Core Values & Principles which include: performing with integrity; passionately focus on client service; embracing a client-centered vision; maintaining contagious enthusiasm for our clients; searching for the best ideas; looking upon change as an opportunity; insisting upon excellence; creating an atmosphere of excitement, informality and trust; focusing on the situation, issue, or behavior, not the person; maintaining the self-confidence and self-esteem of others; maintaining constructive relationships; taking the initiative to make things better; and leading by example.

CCMSI is an Affirmative Action / Equal Employment Opportunity employer offering an excellent benefit package including Medical, Dental, Prescription Drug, Vision, Flexible Spending, Life, ESOP and 401K.

#CCMSICareers #CCMSIIrvine #OfficeLife #GreatPlaceToWork #Hiring #ClaimAssistant #CCMSI #WorkersCompensation #IrvineJobs #CaliforniaJobs #InsuranceCareers #JoinOurTeam #OfficeJobs #CustomerService #CareerGrowth #EmployeeOwned #IND456