Medical Only Claims Representative

Great American Insurance Group; Springfield (IL); Remote; USD 70,000 - 92,000; Full time

Benefits offered by this job

Medical, dental, vision coverage

401(k) with match

Stock purchase plan

Commuter benefits

Paid time off and holidays

Tuition reimbursement

Job summary

SCI Summit Consulting, LLC is seeking a medical-only claims professional to manage and investigate workers’ compensation claims. The role is remote in Illinois and requires strong negotiation and analytical skills to determine liability and settlements.

Salary ranges from $69,600 to $92,400 per year with competitive benefits; a minimum of 5 years in property and casualty claims handling and a related degree are preferred. Full-time position with opportunities for growth.

Qualifications

• Bachelor’s degree in Business Administration, Risk Management and Insurance, Finance, or a related field or equivalent experience.
• Generally, a minimum of 5 years of experience in property and casualty claims handling.
• Completion of or continuing progress toward a professional designation such as AIC is preferred.

Responsibilities

• Manages an inventory of claims to evaluate compensability and liability.
• Plans and conducts claim investigations to confirm coverage and determine liability, compensability, and damages.
• Determines and negotiates settlements/reserves within authority; may attend arbitrations or trials.
• Conveys information regarding coverage and settlements to insureds, claimants, and partners.
• Authorizes payments within authority limits and ensures timely processing.
• Maintains detailed claim files and correspondence.
• This is a Medical Only position.
• This role is remote in Illinois.

Skills

Communication skills

Negotiation

Analytical thinking

Education

Bachelor's degree (Business Administration, Risk Management & Insurance, Finance, or related)

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

Salary Range:$69,600.00 -$92,400.00

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.
• *Excludes seasonal employees and interns.

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