Senior Claims Representative – Medical Only, Workers Compensation

This is a fully remote position, open to applicants in Texas.

📋 Description

• Investigate, assess, and oversee workers’ compensation medical-only claims from the point of initial reporting to resolution.

• Confirm coverage and collect pertinent information to evaluate compensability and devise claim handling strategies.

• Maintain regular communication with injured workers, employers, medical providers, and various stakeholders.

• Authorize or reject medical invoice payments in accordance with company policies and jurisdictional regulations.

• Set and manage claim reserves within the designated authority, including approvals up to $10,000.

• Ensure timely and precise claim documentation and file management.

• Examine medical information and claim specifics to support claim resolutions and cost management.

• Manage medical-only claims in Texas, Arkansas, and Oklahoma in accordance with state regulations.

• Assist with claim administration in other jurisdictions as business needs dictate.

• Handle a substantial caseload while achieving productivity, quality, and service standards.

• Work collaboratively with internal partners and external stakeholders to resolve claims efficiently and effectively.

• Identify problems that necessitate escalation and suggest measures to reduce risk and ensure compliance.

⛳️ Requirements

• High school diploma is mandatory; further education in insurance, claims, or business-related fields is favored.

• At least 2 years of experience in managing workers’ compensation medical-only claims is required.

• Experience with claims management in Texas, Arkansas, and Oklahoma is preferred.

• Familiarity with claims in Minnesota, Kansas, Missouri, Iowa, Nebraska, and South Dakota is advantageous.

• Strong understanding of workers’ compensation claims handling practices, medical bill review, and investigative techniques.

• Exceptional written and verbal communication skills.

• Capability to interact effectively with both internal and external stakeholders.

• Ability to work independently in a remote environment.

• Proficiency in managing multiple priorities while maintaining accuracy in a fast-paced environment.

• Must have authorization to work in the United States without current or future employment visa sponsorship.

🏝️ Benefits

• Medical coverage.

• Dental coverage.

• 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.