Remote Senior Medical-Only Claims Specialist

Great American Insurance; USA; Remote; USD 65.000 - 80.000; Vollzeit

Benefits dieser Stelle

Medical, dental, and vision coverage

401(k) with company match

Tuition reimbursement

Paid Time Off and paid holidays

Commuter benefits

Zusammenfassung

Great American Insurance Group seeks a Senior Medical Only Claims Representative to investigate, manage, and resolve workers' compensation medical-only claims across MN, IA, NE, SD, KS, and MO in a fully remote role.

You will verify coverage, communicate with injured workers and providers, and manage reserves up to $10,000 while ensuring compliance with state regulations and company standards. Strong independence and prioritization are essential.

Qualifikationen

• 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 handling claims in Minnesota, Iowa, Nebraska, South Dakota, Kansas and Missouri preferred.
• Strong knowledge of workers' compensation claims handling practices, medical bill review, and claim investigation techniques.
• Excellent written and verbal communication skills with ability to interact with diverse stakeholders.
• Demonstrated ability to work independently in a remote environment, manage multiple priorities, and maintain accuracy in a fast-paced setting.

Aufgaben

• 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 Minnesota, Iowa, Nebraska, South Dakota, Kansas and Missouri while maintaining compliance with state-specific regulations.
• Support claim administration in Midwestern 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.

Kenntnisse

Communication skills

Independent remote work

Ausbildung

High school diploma

Jobbeschreibung

Great American Insurance Group seeks a Senior Medical Only Claims Representative to investigate, manage, and resolve workers' compensation medical-only claims across MN, IA, NE, SD, KS, and MO in a fully remote role.

You will verify coverage, communicate with injured workers and providers, and manage reserves up to $10,000 while ensuring compliance with state regulations and company standards. Strong independence and prioritization are essential.