Senior Medical-Only Claims Specialist (Remote)

Great American Insurance Group; Ohio; Remote; USD 60,000 - 90,000; Full time

Benefits offered by this job

Medical coverage

Dental coverage

Vision coverage

Wellness programs

Parental leave

Adoption assistance

Tuition reimbursement

Paid time off

Paid holidays

401(k) with company match

Employee stock purchase plan

Commuter benefits

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 a strong customer focus. This fully remote role covers MN, IA, NE, SD, KS and MO, requiring self-motivation and the ability to prioritize independently.

The position emphasizes compliance with jurisdictional requirements, timely communication with workers and providers, and accurate claim documentation while maintaining

Qualifications

• 2+ years of experience handling workers’ compensation medical-only claims.
• Experience handling claims in Minnesota, Iowa, Nebraska, South Dakota, Kansas and Missouri preferred.
• Strong knowledge of workers’ compensation claims handling practices and medical bill review.

Responsibilities

• Investigate, manage, and resolve medical-only claims from initial reporting through resolution.
• Verify coverage and determine compensability and handling strategies.
• Maintain regular communication with injured workers, employers, providers, and other stakeholders.
• Approve or deny medical invoices in accordance with guidelines and regulations.
• Establish and manage claim reserves within delegated authority up to $10,000.
• Ensure timely documentation and file management for claims.
• Analyze medical information to facilitate effective outcomes and cost management.
• Collaborate with internal and external stakeholders to achieve prompt resolution.
• Identify issues requiring escalation and recommend actions to minimize risk.

Skills

Workers' compensation claims handling

Medical bill review

Claim investigation techniques

Remote work independence

Multitasking in fast-paced environment

Education

High school diploma

Insurance/claims/business education preferred

Job description

Great American Insurance Group is seeking a Senior Medical Only Claims Representative to investigate, manage, and resolve workers’ compensation medical-only claims with a strong customer focus. This fully remote role covers MN, IA, NE, SD, KS and MO, requiring self-motivation and the ability to prioritize independently.

The position emphasizes compliance with jurisdictional requirements, timely communication with workers and providers, and accurate claim documentation while maintaining