Medical Only Claims Representative

Summit Insurance Group, Inc.; Springfield (IL); Remote; USD 56,000 - 76,000; Full time

Benefits offered by this job

Medical, dental, vision coverage

401(k) with company match

Paid time off and holidays

Commuter benefits

Job summary

SCI Summit Consulting, LLC is seeking a claims professional to manage and investigate workers’ compensation claims from a remote Illinois location. You will negotiate settlements, maintain secure claim files, and communicate clearly with insureds, claimants, and partners.

The role requires a business/insurance degree, 6 months’ experience in P&C claims, and strong negotiation and analytical skills. Opportunity to advance within a focused workers’ compensation practice and benefit from a robust

Qualifications

• Strong interpersonal and communication skills with the ability to build relationships.
• Knowledge of insurance policies, coverage, and claims handling procedures.
• Ability to organize and prioritize caseloads and handle negotiations.

Responsibilities

• Manages an inventory of claims to evaluate compensability/liability.
• Conducts claim investigations to confirm coverage and determine liability, compensability and damages.
• Determines and may negotiate appropriate claim settlements/reserves within prescribed authority.
• May attend arbitrations, mediations, depositions, or trials.
• Conveys routine to moderately complex information regarding coverage and settlements to insureds, claimants, and external partners.
• May authorize payments within authority limits and ensure timely payments.
• Maintains accurate and detailed claim files including correspondence and settlement agreements.
• Performs other duties as assigned.
• This role is remote in Illinois.

Skills

Interpersonal skills

Communication skills

Negotiation

Analytical thinking

Education

Bachelor's Degree in Business Administration or related field

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.
• Conducts claim investigations to confirm coverage and to determine liability, compensability and damages.
• Determines and may negotiate appropriate claim settlements/reserves within prescribed authority.
• May attend arbitrations, mediations, depositions, or trials.
• Conveys routine to moderately complex information regarding coverage and settlements to insureds, claimants, and external partners.
• May authorize 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.
• Performs other duties as assigned.
• This role is remote in Illinois.

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 6 months 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 specific limits and authority on assignments of moderate technical complexity and coordination. Demonstrates functional analytical, negotiation, and problem-solving skills. Demonstrates knowledge of insurance policies, coverage, and claims handling procedures. Develops and maintains knowledge of industry laws and regulations. Demonstrates ability to organize and prioritize caseloads, ensuring timely resolution of claims. Strong interpersonal and communication skills with the ability to build relationships and handle negotiations. Proven ability to handle confidential information with discretion.

Company

SCI Summit Consulting, LLCSalary Range:$56,400.00 -$75,600.00

Benefits

• We offer competitive benefits packages for full-time and part-time employees*
• Full-time employees have access to medical, dental, and vision coverage, wellness plans, parental leave, adoption assistance, and tuition reimbursement.
• Full-time and eligible part-time employees also enjoy Paid Time Off and paid holidays, a 401(k) plan with company match, an employee stock purchase plan, and commuter benefits.
• 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.

careers .*Excludes seasonal employees and interns.