Remote Senior Medical-Only Claims Specialist

Great American Insurance Group; Clifton (TX); Remote; USD 60,000 - 80,000; Full time

Job summary

Great American Insurance Group is seeking a Senior Medical Only Claims Representative to investigate, manage, and resolve workers’ compensation medical-only claims with accuracy and a strong customer focus.

This fully remote role primarily supports Texas, Arkansas, and Oklahoma, and requires the ability to work independently in a fast-paced environment while maintaining high-quality claim outcomes.

Qualifications

• High school diploma required; additional insurance, claims, or business-related education preferred.
• Minimum of 2 years of experience handling workers’ compensation medical-only claims.
• Experience managing claims in Texas, Arkansas, and Oklahoma preferred; knowledge of MN, KS, MO, IA, NE, SD is a plus.
• Strong knowledge of workers’ compensation claims handling practices, medical bill review, and claim investigation techniques.
• Ability to work independently in a remote environment and manage multiple priorities.

Responsibilities

• 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 guidelines and 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 Texas, Arkansas, and Oklahoma while maintaining compliance with state-specific regulations.
• Support claim administration in the 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.

Skills

Experience handling workers’ comp med‑

Education

High school diploma

Insurance/claims/business education preferred

Job description

Great American Insurance Group is seeking a Senior Medical Only Claims Representative to investigate, manage, and resolve workers’ compensation medical-only claims with accuracy and a strong customer focus.

This fully remote role primarily supports Texas, Arkansas, and Oklahoma, and requires the ability to work independently in a fast-paced environment while maintaining high-quality claim outcomes.