Senior Medical Only Claims Representative

Great American Insurance Group; United States; Remote; USD 70,000 - 92,000; Full time

Benefits offered by this job

Medical, dental, and vision coverage

Wellness plans

Parental leave

Adoption assistance

Tuition reimbursement

Paid time off and holidays

401(k) plan with company match

Employee stock purchase plan

Commuter benefits

Job summary

SCI Summit Consulting, LLC is hiring a medical-only claims examiner for a remote role in Illinois. The position focuses on workers’ compensation claims, investigation, negotiation, and timely settlements, with authority to approve payments and manage case files.

The ideal candidate has a Bachelor’s degree in a related field, 5+ years of P&C claims experience, and may pursue professional designations such as AIC. Benefits include a comprehensive package and GAIG affiliation.

Qualifications

• Bachelor’s degree or equivalent experience in a related field.
• 5 years of property and casualty claims handling experience preferred.
• Professional designation (e.g., AIC) preferred or pursuing

Responsibilities

• Manage an inventory of claims and evaluate compensability/liability.
• Plan and conduct claim investigations to confirm coverage and determine liability and damages.
• Negotiate settlements/reserves within authority; may attend arbitrations or trials.
• Communicate complex coverage and settlement information to insureds, claimants, and partners.
• Authorize payments within authority and ensure timely processing.
• Maintain accurate claim files with correspondence, reports, and settlements.
• Perform other duties as assigned.

Skills

Claims handling

Negotiation

Analytical skills

Communication

Education

Bachelor’s Degree in Business Administration, Risk Management and Insurance, Finance, or related field

Job description

Summit provides independent insurance agents and their clients with market-leading workers’ comp insurance and elite customer service. We’re growing and currently serve more than 7,000 independent agents and 31,000 policyholders across the South, Midwest, and Mid-Atlantic.

Our strength comes from a single-minded focus on workers’ comp and a commitment to long-term customer relationships. Summit is who you turn to when you need a specialist who not only knows workers’ comp but also gets to know your business and your priorities.

Our field team members are located in every state in which we operate.

Summit is a member of the Great American Insurance Group where our highest goal is for all employees to feel included, respected, and empowered to perform at their best.

Essential Job Functions and Responsibilities

• Manages an inventory of claims to evaluate compensability/liability.
• Plans and conducts claim investigations to confirm coverage and to determine liability, compensability and damages.
• Determines and negotiates appropriate claim settlements/reserves within prescribed authority. May attend arbitrations, mediations, depositions, or trials.
• Conveys moderately complex information regarding coverage and settlements to insureds, claimants, and external partners.
• Authorizes payments in accordance with assigned authority limit and ensures payments are made in a timely manner.
• Maintains accurate and detailed claim files, including all correspondence, reports, and settlement agreements.
• This is a Medical Only position.
• This role is remote in Illinois.
• Performs other duties as assigned.

Job Requirements

Education: Bachelor’s Degree in Business Administration, Risk Management and Insurance, Finance, or a related field or equivalent experience.

Experience: Generally, a minimum of 5 years of experience in property and casualty claims handling. Completion of or continuing progress toward a professional designation preferred, such as Associate in Claims (AIC).

Scope of Job/Qualifications: Works within significant limits and authority on assignments of higher technical complexity and coordination. Demonstrates strong analytical, negotiation, and problem-solving skills. Demonstrates knowledge of insurance policies, coverage, and claims handling procedures. Maintains knowledge of industry laws and regulations. Demonstrates ability to organize and prioritize caseloads, ensuring timely resolution of claims. Excellent interpersonal and communication skills with the ability to build relationships and lead negotiations. Proven ability to handle confidential information with discretion.

This job is non-exempt in California and Washington

Company:

SCI Summit Consulting, LLC

Salary Range:

$69,600.00 -$92,400.00

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.