Remote Senior Medical-Only Claims Specialist

Great American Insurance Group; United States; Remote; USD 65,000 - 80,000; Full time

Benefits offered by this job

Competitive benefits

Job summary

Great American Insurance Group, a member of American Financial Group, is seeking a Senior Medical Only Claims Representative for a fully remote role primarily handling Texas, Arkansas, and Oklahoma workers’ compensation medical-only claims. This position requires independence, accuracy, and a strong customer focus.

The role reports to Strategic Comp and offers a salary range of $65,000.00 to $80,000.00 with full-time benefits.

Qualifications

• High school diploma required; additional insurance, claims, or business-related education is preferred.
• Minimum 2 years of experience handling workers’ compensation medical-only claims.
• Experience in TX, AR, OK preferred; MN, KS, MO, IA, NE, SD 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.

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

Claims handling

Medical bill review

Claim investigation

Education

High school diploma

Insurance/claims education preferred

Job description

Great American Insurance Group, a member of American Financial Group, is seeking a Senior Medical Only Claims Representative for a fully remote role primarily handling Texas, Arkansas, and Oklahoma workers’ compensation medical-only claims. This position requires independence, accuracy, and a strong customer focus.

The role reports to Strategic Comp and offers a salary range of $65,000.00 to $80,000.00 with full-time benefits.