Senior Claims Representative - Medical Only, Workers Compensation

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

Working for a leader in the insurance industry means opportunity for you. Great American Insurance Group's member companies are subsidiaries of American Financial Group. We combine a \"small company\" culture where your ideas will be heard with \"big company\" expertise to help you succeed. With over 30 specialty and property and casualty operations, there are always opportunities here to learn and grow. Strategic Comp is a leading provider of workers’ compensation insurance for large employers committed to protecting their workforce. As part of Great American Insurance Group, we combine the strength and stability of a trusted organization with more than 150 years of history with the entrepreneurial spirit of a growing business.
Through our specialized insurance expertise and field-based service model, we build lasting partnerships and deliver exceptional results for our customers. Our culture is built on collaboration, excellence, and a shared commitment to serving our customers and one another.
The Senior Medical Only Claims Representative is responsible for investigating, managing, and resolving workers’ compensation medical-only claims with accuracy, efficiency, and a strong customer focus. This role serves as a key point of contact for injured workers, employers, medical providers, and other stakeholders while ensuring compliance with jurisdictional requirements and company standards. The position handles claims primarily in Texas, Arkansas, and Oklahoma. As a fully remote role, this position requires a self-motivated professional who excels at managing priorities independently while maintaining high-quality claim outcomes.

• 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.

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

Business Unit

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.
Excludes seasonal employees and interns.