Medical Only Claims Representative

SCI Summit Consulting, LLC; United States; Remote; USD 56,000 - 76,000; Full time

Benefits offered by this job

Medical, dental, and vision coverage

Wellness plans

Parental leave

Adoption assistance

Tuition reimbursement

Paid time off

Paid holidays

401(k) with company match

Employee stock purchase plan

Commuter benefits

Job summary

SCI Summit Consulting, LLC is seeking a claims professional to manage workers’ compensation claims with a focus on evaluating compensability, liability, and damages. You will investigate to confirm coverage and negotiate settlements within authority.

The role supports remote work in Illinois with opportunities to collaborate with insureds, claimants, and external partners, handling moderately complex claims and maintaining detailed files.

Qualifications

• Bachelor’s degree in Business Administration, Risk Management and Insurance, Finance, or related field or equivalent experience.
• Minimum of 6 months of experience in property and casualty claims handling; designation such as AIC preferred.
• Knowledge of insurance policies, coverage, and claims handling procedures; ability to organize and negotiate within authority.

Responsibilities

• Manage an inventory of claims to evaluate compensability/liability.
• Conduct investigations to confirm coverage and determine liability and damages.
• May negotiate appropriate claim settlements and reserves within prescribed authority; may attend arbitrations, mediations, depositions, or trials.
• Maintain accurate and detailed claim files with all correspondence and settlement documents.
• Convey information regarding coverage and settlements to insureds, claimants, and external partners; ensure timely payments.

Skills

Analytical skills

Negotiation

Communication skills

Claims knowledge

Education

Bachelor’s Degree in Business/Insurance

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, LLC Salary 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. Learn more at http://www.gaig.com/careers. *Excludes seasonal employees and interns.

Great American Insurance Group

Great American Insurance Group understands the importance of choosing a financially strong company. We are an organization built for the long term and are committed to giving you that strength. Why can you trust Great American Insurance Group? For nearly 150 years, Americans have trusted us to protect them. Our innovative insurance solutions and specialization serves niche marketplaces that we know well. This expertise gives us a successful foundation that spans generations. You never know where a career in insurance will take you. Whether you are starting your career or are looking for a company to grow your experience, at Great American Insurance Group, you can join our more than 8,500 employees to “Be Here. Be GREAT!” To learn more, visit our Career Page