Senior Claims Representative – Medical Only, Workers Compensation

Great American Insurance Group•OH Cin-GA Tower, OH

1d•$65,000 - $80,000•Remote

About The Position

The Senior Medical Only Claims Representative investigates, manages, and resolves workers’ compensation medical-only claims accurately and efficiently, with a strong customer focus. The role is a key point of contact for injured workers, employers, medical providers, and other stakeholders, and ensures compliance with jurisdictional requirements and company standards. Claims are primarily handled in Minnesota, Iowa, Nebraska, South Dakota, Kansas, and Missouri, with support for claim administration in other Midwestern jurisdictions as business needs require. This is a fully remote role requiring independent prioritization and high-quality claim outcomes.

Requirements

High school diploma required.
Generally, at least 2 years of experience handling workers’ compensation medical-only claims.
Strong knowledge of workers’ compensation claims-handling practices, medical bill review, and claim investigation techniques.
Excellent written and verbal communication skills and the ability to interact effectively with varied internal and external stakeholders.
Ability to work independently in a remote environment, manage multiple priorities, and maintain accuracy in a fast-paced setting.

Nice To Haves

Additional insurance-, claims-, or business-related education.
Experience managing claims in Minnesota, Iowa, Nebraska, South Dakota, Kansas, and Missouri.

Responsibilities

Investigate, evaluate, and manage workers’ compensation medical-only claims from initial reporting through resolution.
Verify coverage and gather information to determine compensability and appropriate claim-handling strategies.
Communicate regularly, verbally and in writing, with injured workers, employers, medical providers, and other claim stakeholders.
Approve or deny medical invoice payments in accordance with company guidelines and applicable jurisdictional regulations.
Establish and manage claim reserves within delegated authority, including reserve approvals up to $10,000.
Maintain 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 Minnesota, Iowa, Nebraska, South Dakota, Kansas, and Missouri while complying with state-specific regulations.
Support claim administration in Midwestern jurisdictions as business needs require.
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.