Medical Only Claims Representative – Workers’ Compensation

Location & Practice Overview

The position operates as a remote role eligible for candidates located in Illinois and is tied to Summit’s specialized workers’ compensation claims operation. Work centers on medical-only claim files within a dedicated insurance claims environment that includes internal clinical support resources.

Responsibilities

• Manage an assigned inventory of medical-only workers’ compensation claims, monitoring status and completing required activities on schedule.
• Review policy provisions, coverage terms, medical documentation, and incident information to determine claim compensability and applicable liability.
• Investigate reported workplace injuries by gathering relevant claim information, verifying coverage details, and assessing the circumstances and supporting documentation.
• Determine appropriate reserves and settlements within assigned authority limits and negotiate when authorized.
• Authorize payments within authority and ensure timely processing; maintain complete, accurate claim files including correspondence and settlement documentation.
• Communicate coverage decisions and settlement information to insured employers, claimants, and external partners; attend arbitrations, mediations, depositions, or trials when required.

Day-to-day work emphasizes analytical evaluation of medical-only claim files, documentation integrity, and adherence to individual authority limits while progressing the assigned inventory toward timely resolution.

Qualifications & Requirements

Applicants need foundational property and casualty claims experience and the capacity to manage moderate-complexity assignments inside defined authority parameters.

Compensation & Benefits

The published annual salary range is $56,400–$75,600. Full-time employees receive the organization’s standard benefits package subject to plan eligibility and terms.

• Medical, dental, and vision insurance
• 401(k) retirement plan with company matching
• Paid time off and paid holidays
• Paid parental leave and adoption assistance
• Employee stock purchase plan and tuition reimbursement
• Employee wellness programs and commuter benefits

Schedule & Work Environment

Patient Population & Clinical Setting

This position supports workers’ compensation claims involving employees who report work-related injuries or occupational illnesses. Although the role is not a direct patient-care position, its claims portfolio involves medical treatment expenses and occupational injury documentation. Medical-related claim decisions are supported by access to internal clinical professionals, including nurses and medical directors.

Clinical Focus & Key Services

The medical component of this claims operation connects workers’ compensation coverage with occupational injury-related healthcare expenses. The position operates within an insurance-based medical management framework, with internal clinical professionals available to provide medical perspective when claim circumstances require additional review.

Role Highlights

This Medical Only Claims Representative position offers a focused opportunity within a specialized workers’ compensation insurance operation. The role combines insurance claims expertise with occupational medical management in a remote work environment, supported by dedicated internal clinical professionals. Its defined medical-only scope provides a distinct professional focus compared with general liability, multi-line property and casualty, or lost-time claims positions.

• Specialized medical-only workers’ compensation claims assignment
• Fully remote work arrangement for eligible Illinois-based candidates
• Access to in-house clinical nurses and medical directors
• Dedicated workers’ compensation insurance environment rather than a general healthcare practice
• Opportunity to apply foundational P&C claims experience in a specialized occupational injury setting

About Summit Insurance Group, Inc.

Summit is a specialized workers’ compensation insurance organization and a member of Great American Insurance Group since 2014. Based in Lakeland, Florida, the company serves independent insurance agents and policyholders across the South, Midwest, and Mid-Atlantic. Operations concentrate exclusively on workers’ compensation, encompassing underwriting, claims management, premium audit, and loss prevention.

Frequently Asked Questions

Medical Only Claims Representative in Springfield, IL

Summit Insurance Group, Inc. is offering a Medical Only Claims Representative opportunity associated with Springfield, Illinois, within its specialized workers’ compensation insurance operation. Unlike clinical healthcare positions, this role belongs to the insurance and occupational injury management sector, where medical coverage is evaluated in connection with workplace-related incidents affecting covered employees. The position is part of a dedicated workers’ compensation environment rather than a general medical insurance or healthcare delivery setting. Its medical-only classification distinguishes this specialty within the broader claims profession, connecting insurance administration with occupational health considerations. For candidates exploring Medical Only Claims Representative jobs or Workers’ Compensation Claims careers in Illinois, this position provides a clearly defined specialty and an established insurance-sector setting.