If you have a knack for untangling complex medical files, love helping injured workers navigate the healthcare maze, and want to do meaningful work from anywhere, this Senior Claims Representative role at Great American Insurance Group might be right up your alley. Working within our Strategic Comp division, you will manage medical only claims from start to finish. You get the best of both worlds here, combining the agile, friendly atmosphere of a close team with the backing of a financial powerhouse that has stood strong for more than 150 years. Best of all, this is a fully remote, worldwide opportunity that gives you the independence to deliver top tier service on your own terms.

Role Overview

In this position, you will focus on medical only workers compensation files for large commercial clients. You will investigate injuries, coordinate directly with medical providers, assess treatments, and bring files to a prompt, fair resolution. Because you are dealing strictly with medical claims rather than ongoing indemnity payments, your focus stays dialed in on treatment plans, fee schedules, and swift recovery milestones. You will serve as the crucial bridge between employers, injured personnel, and healthcare facilities across various jurisdictions.

Key Responsibilities

Your day to day will keep you engaged with a broad mix of investigation, coordination, and claims management tasks such as the following

Reviewing newly reported claims to verify coverage, compensability, and proper documentation
Communicating directly with injured workers, treating physicians, and insured employers to clarify treatment paths
Auditing medical bills against applicable state fee schedules and treatment guidelines to keep costs reasonable
Setting and adjusting accurate medical financial reserves in accordance with internal standards
Identifying claims that show early signs of complexity or potential lost time so they can be reassigned smoothly
Coordinating with nurse case managers and utilization review teams to ensure appropriate levels of care
Documenting file notes thoroughly and closing out claims once all treatments and bills wrap up

Requirements

We are searching for an experienced professional who brings both technical claims acumen and genuine empathy to every conversation. Ideal qualifications include

Solid experience directly handling medical only or multi state workers compensation claims
Strong familiarity with medical terminology, ICD codes, and healthcare billing rules
Active state adjuster licensing, or the willingness and capability to obtain reciprocal licenses quickly
Superb written and verbal communication skills for building trust with varied stakeholders
Self directed organizational skills that make working from home second nature
A high school diploma or equivalent, while an associate or bachelor degree is a welcome plus

What You'll Gain

Great American Insurance Group values the unique perspectives every teammate brings. When you join the team, you can look forward to advantages like these

The total flexibility of a fully remote, worldwide opportunity designed to support genuine work life balance
A competitive compensation package with extensive wellness and retirement benefits
Direct collaboration with supportive leaders who actively invest in your professional growth
A workplace culture that celebrates diverse ideas and empowers people to do their finest work