Senior Claims Representative – Medical Only, Workers Compensation

The Senior Medical Only Claims Representative is responsible for investigating, managing, and resolving workers’ compensation medical-only claims with accuracy, efficiency, and a strong customer focus. This role serves as a key point of contact for injured workers, employers, medical providers, and other stakeholders while ensuring compliance with jurisdictional requirements and company standards. The position handles claims primarily in Texas, Arkansas, and Oklahoma. As a fully remote role, this position requires a self-motivated professional who excels at managing priorities independently while maintaining high-quality claim outcomes.

• →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 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.

• High school diploma required; additional insurance, claims, or business-related education is preferred.
• Generally, a minimum of 2 years of experience handling workers’ compensation medical-only claims.
• Experience managing claims in Texas, Arkansas, and Oklahoma preferred. Experience managing claims in MN, KS, MO, IA, NE, SD is a plus.
• 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 effectively interact with a variety of internal and external stakeholders.
• Demonstrated ability to work independently in a remote environment, manage multiple priorities, and maintain accuracy in a fast-paced setting.