Remote Senior Medical-Only Claims Specialist

Great American Insurance; Texas; Remote; USD 65,000 - 80,000; Full time

Benefits offered by this job

Medical, dental, and vision coverage

401(k) plan with company match

Paid time off and holidays

Tuition reimbursement

Commuter benefits

Job summary

Strategic Comp, a leader in workers' compensation insurance and part of Great American Insurance Group, is seeking a Senior Medical Only Claims Representative. This fully remote role handles medical-only workers' comp claims with a focus on Texas, Arkansas, and Oklahoma, prioritizing accuracy, timely communication, and regulatory compliance.

You will assess coverage, determine compensability, manage reserves up to $10,000, collaborate with stakeholders, and maintain high-quality documentation

Qualifications

• Experience handling workers' compensation medical-only claims.
• Strong knowledge of medical bill review and claim investigation.
• Excellent written and verbal communication in a remote environment.

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 company guidelines and applicable 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

Remote work

Claims handling

Communication

Independent work

Education

High school diploma

Job description

Strategic Comp, a leader in workers' compensation insurance and part of Great American Insurance Group, is seeking a Senior Medical Only Claims Representative. This fully remote role handles medical-only workers' comp claims with a focus on Texas, Arkansas, and Oklahoma, prioritizing accuracy, timely communication, and regulatory compliance.

You will assess coverage, determine compensability, manage reserves up to $10,000, collaborate with stakeholders, and maintain high-quality documentation