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GA
Great American Insurance Group
Claims Representative (Medical Only)
Career Insights for Medical Claims Processor / Representative
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Based on Louisiana data
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What they do
A Medical Claims Processor or Representative reviews and processes medical insurance claims and determines whether an insurance policy will cover a medical procedure. Gathers information from policy holders and organizes insurance files; may process checks with payments to policy holders when a medical claim is approved.
$41,082 / year median in Louisiana
-3% projected decline
Job Description
Summit provides independent insurance agents and their clients with market-leading workers' comp insurance and elite customer service. We're growing and currently serve more than 7,000 independent agents and 31,000 policyholders across the South, Midwest, and Mid-Atlantic. Our strength comes from a single-minded focus on workers' comp and a commitment to long-term customer relationships. Summit is who you turn to when you need a specialist who not only knows workers' comp but also gets to know your business and your priorities. Our field team members are located in every state in which we operate. Summit is a member of the Great American Insurance Group where our highest goal is for all employees to feel included, respected, and empowered to perform at their best. Great American's culture is built on connection, shared learning, and strong relationships. To support this, employees in this role are expected to be on-site four days a week, with the flexibility to work one day remotely. Core in-office days are Tuesday-Thursday, with the fourth day determined by business needs. Essential Job Functions and Responsibilities Manages an inventory of claims to evaluate compensability/liability. Conducts claim investigations to confirm coverage and to determine liability, compensability and damages. Determines and may negotiate appropriate claim settlements/reserves within prescribed authority. May attend arbitrations, mediations, depositions, or trials. Conveys routine to moderately complex information regarding coverage and settlements to insureds, claimants, and external partners. May authorize payments in accordance with assigned authority limit and ensures payments are made in a timely manner. Maintains accurate and detailed claim files, including all correspondence, reports, and settlement agreements. Performs other duties as assigned.