Medical Claims Representative – Workers’ Compensation (Albuquerque)

The Workers’ Compensation Medical Only Claim Representative is responsible for managing medical-only workers’ compensation claims for multiple client accounts across various industries. This position focuses on the timely and accurate adjudication of claims in compliance with New Mexico statutes, client expectations, and CCMSI standards.

Requirements

• Adjudicate medical-only workers’ compensation claims timely and accurately in accordance with statutory, client, and CCMSI guidelines.
• Establish and maintain claim reserves within authority levels under direct supervision.
• Review, approve, and negotiate medical and miscellaneous invoices to ensure appropriate and related charges.
• Coordinate and monitor medical treatment in compliance with corporate claim standards.
• Document all claim activity, medical updates, and correspondence in the claim system.
• Close claim files when appropriate and assist with file maintenance as needed.
• Provide support to the broader claim team, including client service initiatives and administrative tasks.
• Maintain compliance with all Corporate Claim Standards and client-specific handling instructions.

Benefits

• Paid time off
• Medical, dental, vision, life, and disability insurance
• 401(k) and Employee Stock Ownership Plan (ESOP)
• Career growth opportunities