Senior Claims Representative – Medical Only, Workers Compensation

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

Be Here. Be Great. 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.

At Great American, we value and recognize the benefits derived when people with different backgrounds and experiences work together to achieve business results. Our goal is to create a workplace where all employees feel included, empowered, and enabled to perform at their best.

This position is not eligible for employment visa sponsorship. Applicants must be authorized to work in the United States without the need for current or future sponsorship.

WhoWeAre

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 specializedinsuranceexpertiseandfield-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.

Position Overview

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.

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.

Qualifications

• 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.
• Excellent written and verbal communication skills with the ability to effectively interact with a variety of internal and external stakeholders.
• Demonstrated ability to work independently in a remote environment, manage multiple priorities, and maintain accuracy in a fast-paced setting.

Business Unit:

Strategic Comp

Salary Range:

$65,000.00 -$80,000.00

Benefits:

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.

Compensation varies by role, level, and location and is influenced by skills, experience, and business needs. Your recruiter will provide details about benefits and specific compensation ranges during the hiring process. Learn more at http://www.gaig.com/careers.

*Excludes seasonal employees and interns.