Senior Claims Representative – Medical Only, Workers Compensation

🔥 1 minute ago

🇺🇸 United States – Remote

💵 $65k - $80k / year

⏰ Full Time

🟠 Senior

📋 Claims Specialist

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Great American Insurance Group

WebsiteLinkedInAll Job Openings

5001 - 10000 employees

🛡️ Insurance

🤝 B2B

Insurance • B2B

Great American Insurance Group is a U. S. -based specialty insurance company that provides a wide range of commercial insurance products and services to businesses and niche industries. With more than 150 years of history and headquarters in Cincinnati, Ohio, Great American offers tailored coverages including property & inland marine, equine mortality, transportation, professional liability, trade credit, cyber risk, and employer health solutions through numerous specialty divisions and international branches. It is a group of insurance companies that are subsidiaries of American Financial Group and emphasizes financial strength, claims expertise, and industry-focused underwriting for primarily business customers.

📋 Description

• Investigate, evaluate, and manage workers’ compensation medical-only claims from initial reporting through resolution • Verify coverage and gather relevant information to determine compensability and appropriate claim handling strategies • Maintain regular verbal and written communication with injured workers, employers, medical providers, and other claim stakeholders • Approve or deny payment of medical invoices in accordance with company guidelines and applicable jurisdictional regulations • Establish and manage claim reserves within delegated authority levels, including reserve approvals up to $10,000 • Ensure timely and accurate claim documentation, file management, and resolution activities • Analyze medical information and claim details to facilitate effective claim outcomes and cost management • Handle medical-only claims in Minnesota, Iowa, Nebraska, South Dakota, Kansas and Missouri while maintaining compliance with state-specific regulations • Support claim administration in Midwestern jurisdictions as business needs require • Prioritize and manage a high-volume caseload while meeting productivity, quality, and service expectations • Collaborate with internal partners and external stakeholders to achieve prompt and effective claim resolution • Identify issues requiring escalation and recommend appropriate actions to minimize risk and ensure compliance

🎯 Requirements

• High school diploma required • Generally, a minimum of 2 years of experience handling workers’ compensation medical-only claims • Experience managing claims in Minnesota, Iowa, Nebraska, South Dakota, Kansas and Missouri preferred • Strong knowledge of workers’ compensation claims handling practices, medical bill review, and claim investigation techniques • Excellent written and verbal communication skills with the ability to effectively interact with a variety of internal and external stakeholders • Demonstrated ability to work independently in a remote environment, manage multiple priorities, and maintain accuracy in a fast-paced setting • Must be authorized to work in the United States without the need for current or future employment visa sponsorship

🏖️ Benefits

• Medical coverage • Dental coverage • Vision coverage • Wellness plans • Parental leave • Adoption assistance • Tuition reimbursement • Paid Time Off • Paid holidays • 401(k) plan with company match • Employee stock purchase plan • Commuter benefits