Medical Only Claims Representative

Summit Insurance Group, Inc.; Alton (IL); Remote; USD 70,000 - 92,000; Full time

Benefits offered by this job

Medical

Dental

Vision

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

Job summary

SCI Summit Consulting, LLC is seeking a Medical Only Workers’ Compensation Claims Adjuster to manage and investigate a remote Illinois caseload. You will evaluate compensability, determine liability, and negotiate settlements while maintaining detailed claim files.

The role requires a Bachelor’s degree in a related field and at least five years of property and casualty claims experience; AIC designation is preferred. We offer competitive benefits and a path for professional growth.

Qualifications

• Bachelor’s Degree in Business Administration, Risk Management and Insurance, Finance, or related field.
• Minimum 5 years of property and casualty claims handling.
• Professional designation (AIC) preferred or in progress.

Responsibilities

• Manages an inventory of claims to evaluate compensability/liability.
• Plans and conducts claim investigations to confirm coverage and determine liability, compensability and damages.
• Determines and negotiates appropriate claim settlements/reserves within prescribed authority; may attend arbitrations, mediations, depositions, or trials.
• Conveys moderately complex information regarding coverage and settlements to insureds, claimants, and external partners.
• Authorizes payments within assigned authority and ensures timely payments.
• Maintains accurate and detailed claim files including correspondence, reports, and settlements.

Education

Bachelor’s Degree in Business Administration, Risk Management and Insurance, Finance, or related field

Professional designation (AIC) preferred or in progress

Job description

Summit provides independent insurance agents and their clients with market-leading workers’ comp insurance and elite customer service. We’re growing and currently serve more than 7,000 independent agents and 31,000 policyholders across the South, Midwest, and Mid-Atlantic. Our strength comes from a single-minded focus on workers’ comp and a commitment to long-term customer relationships. Summit is who you turn to when you need a specialist who not only knows workers’ comp but also gets to know your business and your priorities.

Our field team members are located in every state in which we operate.

Summit is a member of the Great American Insurance Group where our highest goal is for all employees to feel included, respected, and empowered to perform at their best.

Essential Job Functions and Responsibilities

• Manages an inventory of claims to evaluate compensability/liability.
• Plans and conducts claim investigations to confirm coverage and to determine liability, compensability and damages.
• Determines and negotiates appropriate claim settlements/reserves within prescribed authority. May attend arbitrations, mediations, depositions, or trials.
• Conveys moderately complex information regarding coverage and settlements to insureds, claimants, and external partners.
• Authorizes payments in accordance with assigned authority limit and ensures payments are made in a timely manner.
• Maintains accurate and detailed claim files, including all correspondence, reports, and settlement agreements.
• This is a Medical Only position.
• This role is remote in Illinois.
• Performs other duties as assigned.

Job Requirements

• Education: Bachelor’s Degree in Business Administration, Risk Management and Insurance, Finance, or a related field or equivalent experience.
• Experience: Generally, a minimum of 5 years of experience in property and casualty claims handling. Completion of or continuing progress toward a professional designation preferred, such as Associate in Claims (AIC).

Scope of Job/Qualifications: Works within significant limits and authority on assignments of higher technical complexity and coordination. Demonstrates strong analytical, negotiation, and problem‑solving skills. Demonstrates knowledge of insurance policies, coverage, and claims handling procedures. Maintains knowledge of industry laws and regulations. Demonstrates ability to organize and prioritize caseloads, ensuring timely resolution of claims. Excellent interpersonal and communication skills with the ability to build relationships and lead negotiations. Proven ability to handle confidential information with discretion.

This job is non-exempt in California and Washington

Company:

SCI Summit Consulting, LLC

Salary Range:

$69,600.00 -$92,400.00

Benefits:

We offer competitive benefits packages for full-time and part-time employees*.

• medical
• dental
• 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

*Excludes seasonal employees and interns.

Compensation varies by role, level, and location and is influenced by skills, experience, and business needs. Your recruiter will provide details about benefits and specific compensation ranges during the hiring process. Learn more at .