Senior Medical-Only Claims Specialist (Remote – Midwest)

Great American Insurance Group; Oregon; Hybrid; USD 65,000 - 80,000; Full time

Benefits offered by this job

Medical, dental, and vision coverage

Paid time off

401(k) with company match

Employee stock purchase plan

Commuter benefits

Tuition reimbursement

Job summary

Great American Insurance Group’s Strategic Comp division 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 serves injured workers, employers, and providers across Midwest jurisdictions.

The ideal candidate has at least 2 years of workers’ compensation claims experience, a high school diploma, and proven ability to work independently in a remote environment.

Qualifications

• Strong knowledge of workers' compensation claims handling practices, medical bill review, and claim investigation techniques.
• Excellent written and verbal communication skills.
• Demonstrated ability to work independently in a remote environment, manage multiple priorities, and maintain accuracy in a fast-paced setting.

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.

Skills

Claims handling

Education

High School Diploma

Job description

Great American Insurance Group’s Strategic Comp division 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 serves injured workers, employers, and providers across Midwest jurisdictions.

The ideal candidate has at least 2 years of workers’ compensation claims experience, a high school diploma, and proven ability to work independently in a remote environment.