Senior Claims Representative – Medical Only, Workers Compensation

Great American Insurance Group•TX Work at Home, TX

23h•$65,000 - $80,000•Remote

About The Position

The Senior Medical Only Claims Representative investigates, manages, and resolves workers’ compensation medical-only claims with accuracy, efficiency, and a strong customer focus. The position 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 Texas, Arkansas, and Oklahoma, with support for other jurisdictions as business needs require. This is a fully remote role for a self-motivated professional who can manage priorities independently while maintaining high-quality claim outcomes.

Requirements

High school diploma required.
Generally, a minimum of 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, with the ability to interact effectively with a variety of 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 Texas, Arkansas, and Oklahoma.
Experience managing claims in Minnesota, Kansas, Missouri, Iowa, Nebraska, or South Dakota.

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.
Handle medical-only claims in Texas, Arkansas, and Oklahoma while maintaining compliance with state-specific regulations.
Support claim administration in other 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.