Medical Claims Representative – Workers Albuquerque

Overview

Location:

Albuquerque, NM (In-Office).

Schedule:

Monday–Friday, 8:00 a.m. – 4:30 p.m. (37.5 hours per week). Compensation: $20.00 per hour.

Build Your Career With Purpose  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.

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. It offers structured training, mentorship, and the opportunity to develop foundational adjusting skills in a collaborative, in-office environment.

• 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.

• Associate degree or two (2) years of related business experience
• NM Adjuster’s License or ability to obtain within 90 days of hire (must pass state licensing exam and background check)
• Proficiency in Microsoft Office (Word, Excel, Outlook)

• Previous workers’ compensation or claim handling experience
• Knowledge of medical terminology is very helpful
• Bilingual (Spanish) proficiency — highly valued for communicating with claimants, employers, or vendors, but not required.

• 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

• Quality claim handling – thorough investigations, strong documentation, well-supported decisions
• Compliance & audit performance – adherence to jurisdictional and client standards
• Timeliness & accuracy – purposeful file movement and dependable execution
• Client partnership – proactive communication and strong follow-through
• Professional judgment – owning outcomes and solving problems with integrity
• Cultural alignment – believing every claim represents a real person and acting accordingly

The posted salary reflects CCMSI’s good-faith estimate in accordance with applicable pay transparency laws. Actual compensation will be based on qualifications, experience, geographic location, and internal equity. This role may also qualify for bonuses or additional forms of pay. CCMSI offers comprehensive benefits including medical, dental, vision, life, and disability insurance. Paid time off accrues throughout the year in accordance with company policy, with paid holidays and eligibility for retirement programs in accordance with plan documents.

Visa Sponsorship: CCMSI does not provide visa sponsorship for this position.

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