CCMSI Claim Representative, Medical Malpractice Salary in the United States

Overview

At VCM, a division of CCMSI, we look for the best and brightest talent to join our team of professionals.  As a leading Third Party Administrator in self-insurance services, we are united by a common purpose of delivering exceptional service to our clients.  As an Employee-Owned Company, we focus on developing our staff through structured career development programs, rewarding and recognizing individual and team efforts.  Certified as a Great Place To Work, our employee satisfaction and retention ranks in the 95th percentile.     

Reasons you should consider a career with CCMSI:

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

Claim Representative, Medical Malpractice is responsible for handling of all aspects of a claims file from beginning to conclusion, including investigation, determination of liability, confirmation of coverage, establishment of damages, and negotiation and settlement of claims. The Claims Representative has authority to make payment of assigned claims within prescribed limits.

Responsibilities

• Review Incident Reports to determine possible claims and trouble areas. Evaluate all claims assigned in order to make the proper disposition. Investigate all issues to determine cause, scope, damages, and exposure potential. 
• Manage an inventory of claim files to ensure timely resolution of all assigned claims. Maintain files in an organized manner. Document all activity to support the outcome of the claim file.

• Evaluate and negotiate the resolution of claims, while mitigating damages, to achieve cost effective claim outcomes. Negotiate with Claimant or his/her representative to arrive at a reasonable and amicable settlement , where indicated.

• Assist defense counsel in preparing cases, as requested. Control allocated expenses to the claim file.

• Direct, control, and manage the work of vendor partners to ensure their work meets VCM quality expectations.

• Establish a mutually acceptable liaison with his/her assigned client on behalf of VCM. Create a high level of client satisfaction.

• Operate in a team environment. Support other team members to enhance overall team productivity.

• Performs 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, skill, and/or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

• Excellent verbal and written communication and interpersonal skills required.
• Ability to work independently under tight deadlines and handle multiple tasks simultaneously.
• Must have organizational skills and be detail oriented.
• Works well both independently and collaboratively in a team 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                                                                    

Bachelor’s degree and/or professional insurance designations, and/or relevant long term experience preferred.

5-7 year’s handling insurance claims required. Medical malpractice and general liability preferred.

Computer Skills                                                               

Proficient with Microsoft Office programs, general database experience and Internet communication. 

Certificates, Licenses, Registrations

Must have a valid driver’s license and proof of current automobile liability coverage.

Physical Demands

The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

Object Handling Categories

Work requires the ability to lift/carry objects routinely as follows:

       Light Lifting:          No lifting of objects weighing more than 15 pounds on a regular basis.

Other Physical Demands

Work requires the ability to sit or stand up to 7.5 or more hours at a time.

Work requires sufficient auditory and visual acuity to interact with others.

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.