Workers’ Compensation Medical Only Claim Representative

Job Summary

The Medical Only Claim Representative is responsible for handling designated medical-only workers' compensation claims for multiple accounts across Kansas and Missouri. This role manages a high-volume, low-complexity caseload and supports injured workers, medical providers, and internal claim teams by ensuring timely medical coordination, accurate documentation, and responsive communication.

Responsibilities

• Set up and manage medical-only claim files in accordance with corporate claim standards and applicable laws
• Establish reserves and provide reserve recommendations within established authority levels under direct supervision
• Review and approve medical and miscellaneous invoices for designated claims; negotiate disputed bills or invoices under direct supervision
• Request and monitor medical treatment in accordance with corporate claim handling standards
• Summarize correspondence and medical records in claim system notes and appropriately file documentation
• Close claim files when appropriate and retrieve closed files for re-filing as requested
• Provide administrative and claim processing support to claim staff and client service teams
• Communicate with providers, claimants, and internal partners as needed; frequent phone work is required
• Maintain accurate diaries, documentation, and compliance with special client handling instructions

Required Qualifications

• Associate Degree or two (2) years of related business experience
• Strong organizational skills with the ability to multitask in a high-volume environment
• Comfort working on the phone and communicating with external parties on occasion
• Ability to type and work efficiently on a computer
• Proficiency with Microsoft Office applications including Word, Excel, and Outlook
• Reliable, predictable attendance during assigned business hours

Nice to Have

• Knowledge of medical terminology
• Prior experience in a claims, medical, or administrative support role
• Experience supporting multiple accounts or clients simultaneously
• Bilingual (Spanish) proficiency — highly valued for communicating with claimants, employers, or vendors