Workers' Compensation Claims Analyst

November 18

🌾 Iowa – Remote

Although this job is listed in Iowa, this company may be open to hiring remote in other states.

🤠 Texas – Remote

Although this job is listed in Texas, this company may be open to hiring remote in other states.

💵 $83.9k - $115.6k / year

⏰ Full Time

🟠 Senior

🔴 Lead

🧐 Analyst

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EMC Insurance Companies

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Insurance

EMC Insurance Companies is a mutual insurance firm providing specialized business insurance solutions. They focus on commercial property insurance, liability insurance, workers' compensation, and business owners' policies. With a strong emphasis on personalized service, EMC collaborates closely with local agents to deliver comprehensive and tailored coverage. EMC is committed to understanding the unique challenges faced by its policyholders, offering risk management and loss control resources to help businesses safeguard their assets. Known for their dedicated partnerships and exceptional customer service, EMC ensures that businesses are prepared for the unexpected with their superior insurance solutions.

1001 - 5000 employees

Founded 1911

📋 Description

• Reviews claim notices, lawsuits, contracts, and policies to verify coverage • Initiates timely contact with customers and explains the claim process • Obtains statements from insureds, claimants, and witnesses • Evaluate reassigned files as they reach the complex level • Documents claims activities, reserve analysis, summaries of reports • Completes thorough analysis of pertinent facts and sets reserves • Re-evaluates claim as new facts are identified • Secures all necessary official reports, claim forms, and documents • Reviews bills, invoices, and receipts for accuracy • Notifies all parties involved that require appropriate notice • Calculates benefits due and pays accordingly • Coordinates return to work with medical provider • Maintains accurate and timely diaries on all files • Coordinates Medicare set-aside and lien issues • Identifies coverage concerns and resolves questions • Recommends and selects appropriate defense counsel • Identifies, investigates, and pursues opportunities for recovery • Handles litigation of severe and complex workers’ compensation claims • Collaborates with defense counsel on action plans • Drafts independent medical exam and denial letters • Communicates with insureds and attorneys to negotiate settlements • Prepares settlement evaluations and negotiation ranges • Attends depositions, hearings, trials, and mediations • Issues timely settlement payments • Investigates Medicare liens and resolves accordingly • Manages claim recoveries including offsets • Complies with all state-specific reporting requirements • Submits referrals to Special Investigation and other units • Prepares risk alerts for Underwriting and Risk Improvement

🎯 Requirements

• Bachelor’s degree or equivalent relevant experience • Eight years of workers’ compensation claims adjusting experience or related experience • Attainment of all applicable state licenses within six months of hire • Relevant insurance designations preferred • Superior knowledge of best claims practices • Advanced knowledge of the claim function • Excellent knowledge of insurance contracts, medical terminology and laws • Ability to adhere to high standards of professional conduct • Excellent knowledge of computers and claims systems • Exceptional organizational and written and verbal communication skills • Excellent customer service skills • Superior investigative and problem-solving abilities • Travel required; a valid driver’s license with an acceptable motor vehicle report required if driving

🏖️ Benefits

• Health insurance • 401(k) matching • Flexible working hours • Paid time off • Volunteer time off • Professional development • Tuition reimbursement • Wellness initiatives • Recognition and anniversary awards