Senior Medical-Only Claims Specialist (Remote)

Great American Insurance Group; Cincinnati (OH); Remote; USD 65,000 - 80,000; Full time

Benefits offered by this job

Medical, dental, and vision coverage

Wellness plans

Parental leave

Adoption assistance

Tuition reimbursement

Paid time off

Paid holidays

401(k) plan with company match

Employee stock purchase plan

Commuter benefits

Job summary

Great American Insurance Group seeks a Senior Medical Only Claims Representative to investigate and manage workers’ compensation medical-only claims across Minnesota, Iowa, Nebraska, South Dakota, Kansas, and Missouri. This fully remote role requires a self-motivated professional who prioritizes accuracy and customer service.

You will verify coverage, handle invoices, set reserves up to $10,000, maintain clear communication with injured workers and providers, and collaborate with internal

Qualifications

• Strong knowledge of workers’ compensation claims handling practices.
• Experience with medical bill review and claim investigation techniques.
• Excellent written and verbal communication with stakeholders.

Responsibilities

• Investigate, evaluate, and manage workers’ compensation medical-only claims from initial reporting through resolution.
• Verify coverage and gather information to determine compensability and strategies.
• Maintain regular verbal and written communication with injured workers, employers, medical providers, and stakeholders.
• Approve or deny payment of medical invoices in accordance with guidelines and regulations.
• Establish and manage claim reserves up to $10,000.
• Ensure timely and accurate claim documentation and resolution activities.
• Analyze medical information to facilitate effective outcomes and cost management.
• Handle medical-only claims in Minnesota, Iowa, Nebraska, South Dakota, Kansas and Missouri with compliance.
• Support claim administration in Midwestern jurisdictions as needed.
• Prioritize and manage a high-volume caseload; meet productivity and service expectations.
• Collaborate with internal and external partners to achieve prompt resolutions.
• Identify issues requiring escalation and recommend actions to minimize risk.

Skills

Workers' compensation knowledge

Medical bill review

Claim investigation techniques

Excellent written & verbal comms

Education

High school diploma

Insurance/claims/business education preferred

Job description

Great American Insurance Group seeks a Senior Medical Only Claims Representative to investigate and manage workers’ compensation medical-only claims across Minnesota, Iowa, Nebraska, South Dakota, Kansas, and Missouri. This fully remote role requires a self-motivated professional who prioritizes accuracy and customer service.

You will verify coverage, handle invoices, set reserves up to $10,000, maintain clear communication with injured workers and providers, and collaborate with internal