Why Great American Insurance Group?
Great American Insurance Group (GAIG) is a trusted name in the insurance industry for nearly 150 years. With a diversified portfolio that spans more than 30 specialty and property‑and‑casualty operations, we combine the agility of a “small‑company” culture with the resources and expertise of a national leader. Our mission is simple yet powerful: protect people, families, and organizations from unexpected financial hardships by delivering fast, reliable, and compassionate insurance solutions.
Our Accident & Health division, known as POMI, focuses on accident insurance for volunteers, participants, students, athletes, and nonprofit organizations. By streamlining the claims experience, we give our clients peace of mind and the confidence to keep doing what they love. As a member company of the American Financial Group family, we are financially strong, innovative, and committed to long‑term growth—for our customers and for the talented professionals who help us succeed.
Position Overview: Remote Accident & Health Claims Representative
We are searching for a motivated, detail‑oriented, and customer‑centric professional to join our dynamic claims team. In this fully remote role, you will be at the front line of the claims journey, investigating, evaluating, and resolving accident and health claims with empathy and precision. Your work will directly impact the lives of claimants who depend on timely assistance after an injury, making every interaction meaningful and rewarding.
Our ideal candidate thrives in a fast‑paced environment, possesses strong analytical abilities, and enjoys collaborating with a diverse set of stakeholders—including policyholders, medical providers, third‑party administrators, attorneys, and internal underwriting partners. If you are eager to build a rewarding career in insurance while working from the comfort of your home, this opportunity is for you.
Key Responsibilities
As a Remote Accident & Health Claims Representative, you will be accountable for the full spectrum of claim handling, from intake through resolution. Your day‑to‑day duties will include, but are not limited to:
- Claim Investigation & Data Gathering: Review policy coverage, assess liability, and collect all necessary documentation such as medical records, bills, explanation of benefits, receipts, and release forms.
- Subrogation Identification: Identify potential subrogation opportunities, prepare subrogation files, and coordinate with relevant parties to recover costs where applicable.
- Data Entry & System Management: Accurately input claim information into our claims management platform (Guidewire ClaimCenter preferred) and maintain meticulous records to support auditability and compliance.
- Resolution & Settlement: Evaluate claim validity, calculate reserves, and recommend settlement amounts within authorized limits; collaborate with senior adjusters for high‑value or complex cases.
- Payment Processing: Ensure timely issuance of claim payments, verify payment accuracy, and communicate payment details to claimants and other stakeholders.
- Customer Communication: Explain coverage, deductibles, claim decisions, and next steps in clear, compassionate language; respond to inquiries via phone, email, or secure messaging platforms.
- Collaboration & Coordination: Work closely with third‑party administrators, healthcare providers, attorneys, agents, brokers, and internal teams to facilitate smooth claim handling.
- Compliance & Quality Assurance: Adhere to state statutes, federal regulations, and GAIG internal policies; conduct self‑reviews to ensure claims meet quality standards.
- Continuous Improvement: Participate in training sessions, share process improvement ideas, and support departmental initiatives aimed at enhancing efficiency and service quality.
- Additional Projects: Take on assigned special projects or ad‑hoc tasks that contribute to the growth and effectiveness of the claims division.
Essential Qualifications
To succeed in this role, you should demonstrate the following core competencies and experiences:
- Attention to Detail: Proven ability to meticulously review documentation, spot inconsistencies, and ensure data accuracy throughout the claims lifecycle.
- Clear Communication Skills: Strong verbal and written communication capabilities; able to convey complex insurance concepts in an understandable manner.
- Customer Service Orientation: Experience delivering high‑quality service, handling difficult conversations with tact, and resolving issues to the satisfaction of claimants and partners.
- Claims Processing Experience: At least 6 months to 3 years of experience processing injury or health‑related claims, including handling medical bills and explanation of benefits.
- Critical Thinking & Problem Solving: Ability to analyze moderate‑complex scenarios, identify root causes, and make sound decisions within defined authority levels.
- Educational Background: Bachelor’s degree or equivalent experience in liberal arts, business, or a related field.
- Licensing & Training: Willingness and ability to complete required licensing, certifications, and ongoing training programs.
- Technology Proficiency: Comfortable using office productivity suites (Microsoft Office, Google Workspace) and learning new claims management software.
Preferred Qualifications & Experience
- Hands‑on experience with Guidewire ClaimCenter or similar claims administration platforms.
- Previous exposure to subrogation processes and recovery strategies.
- Knowledge of state‑specific insurance regulations governing accident and health policies.
- Experience working in a remote or hybrid environment, demonstrating self‑discipline and effective time management.
- Professional certifications such as AIC (Associate in Claims) or CPCU (Chartered Property & Casualty Underwriter).
Core Skills and Competencies for Success
- Analytical Acumen: Ability to interpret medical terminology, billing codes, and policy language to assess claim validity.
- Empathy & Emotional Intelligence: Sensitivity to claimants’ circumstances, delivering support with compassion while maintaining objectivity.
- Organizational Skills: Managing multiple claims simultaneously, meeting deadlines, and prioritizing tasks effectively.
- Team Collaboration: Working cross‑functionally with underwriters, legal counsel, and external partners to achieve optimal outcomes.
- Adaptability: Thriving in a dynamic environment where regulations, procedures, and technologies evolve regularly.
- Integrity & Ethics: Upholding the highest standards of confidentiality, fairness, and compliance.
Career Growth & Learning Opportunities
At Great American, your professional development is a strategic priority. As a remote claims representative, you will have access to a robust learning ecosystem that includes:
- Structured Training Programs: Comprehensive onboarding, ongoing webinars, and e‑learning modules covering claims best practices, regulatory updates, and advanced investigation techniques.
- Mentorship & Coaching: Pairing with senior adjusters and managers who can provide guidance, feedback, and career‑path advice.
- Certification Support: Financial assistance for industry‑recognized certifications (e.g., AIC, CPCU) and exam preparation resources.
- Clear Promotion Pathways: Opportunities to advance to Senior Claims Representative, Claims Analyst, Claims Supervisor, and eventually into leadership or specialized underwriting roles.
- Cross‑Functional Exposure: Projects that allow collaboration with underwriting, product development, and risk management teams, broadening your insurance knowledge.
- Innovation Initiatives: Participation in process‑improvement and digital transformation initiatives, positioning you at the forefront of industry change.
Compensation, Perks & Benefits
We recognize that competitive remuneration and holistic benefits are essential for attracting and retaining top talent. While exact figures vary based on experience, location, and role level, successful candidates can expect:
- Salary Range: $50,000 – $58,000 annually, with performance‑based incentives.
- Health & Wellness: Medical, dental, and vision coverage starting on day one, with a range of plan options.
- Retirement Savings: 401(k) plan featuring a company match to help you build long‑term financial security.
- Paid Time Off: Generous PTO, paid holidays, and flexible leave policies to support work‑life balance.
- Family Support: Paid parental leave, adoption assistance, and family‑friendly policies.
- Financial Benefits: Employee Stock Purchase Plan, commuter reimbursement, and potential travel allowances for occasional on‑site meetings.
- Learning & Development: Education reimbursement for relevant courses, certifications, and professional development programs.
- Remote Work Enablement: Home office stipend, technology support, and access to secure collaboration platforms.
Work Environment & Company Culture
Great American fosters an inclusive, collaborative, and innovative workplace where every voice matters. Our culture is built on three pillars:
- Diversity & Inclusion: A commitment to hiring, developing, and retaining talent from varied backgrounds, ensuring diverse perspectives drive better decision‑making.
- Employee Empowerment: A “small‑company” mindset that encourages you to share ideas, take ownership, and influence positive change.
- Community Responsibility: Engaging in corporate social responsibility initiatives, volunteer programs, and partnerships that give back to the communities we serve.
Even though this is a remote position, you will be part of a vibrant virtual community. Regular team huddles, virtual coffee chats, and digital collaboration tools keep you connected with peers, managers, and senior leadership, ensuring you never feel isolated.
Application Process & Next Steps
If you are ready to launch or accelerate your claims career with a respected industry leader, we invite you to apply today. The selection process includes an initial screening, a virtual interview, and a brief assessment to gauge your claims acumen. Throughout the process, our recruiting team will keep you informed and answer any questions you may have about the role, compensation, or culture.
Take the Next Step
Are you prepared to make a meaningful impact on the lives of individuals who need your expertise and compassion? Click the link below to submit your application, and let’s discuss how you can become an essential part of Great American’s success story.
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