Senior Remote Medical-Only WC Claims Specialist

Great American Insurance Group; Austin (TX); Remote; USD 65,000 - 85,000; 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 is seeking a Senior Medical Only Claims Representative to investigate, manage, and resolve workers’ compensation medical-only claims with a strong customer focus. The role covers Texas, Arkansas and Oklahoma and is fully remote, requiring self-motivation and the ability to prioritize independently.

With a minimum of 2 years’ experience in medical-only claims and knowledge of bill review, you will communicate with injured workers, employers, providers, and

Qualifications

• Minimum 2 years of experience handling workers’ compensation medical-only claims.
• Experience managing claims in TX, AR and OK preferred; MN, KS, MO, IA, NE, SD is 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 and manage multiple priorities in a fast-paced setting.
• High school diploma required; additional insurance, claims, or business-related education preferred.

Responsibilities

• Investigate, manage, and resolve workers’ compensation medical-only claims from initial reporting through resolution.
• Verify coverage and gather 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

Independent remote work

Multitasking capability

Attention to detail

Customer-focused communication

Education

High School Diploma

Insurance/Claims or 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. The role covers Texas, Arkansas and Oklahoma and is fully remote, requiring self-motivation and the ability to prioritize independently.

With a minimum of 2 years’ experience in medical-only claims and knowledge of bill review, you will communicate with injured workers, employers, providers, and