Medical Only Claims Representative

🔥 0 minutes ago

🇺🇸 United States – Remote

💵 $47k - $71.4k / year

⏰ Full Time

🟢 Junior

📋 Claims Specialist

👻 Ghost score 0%

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EMC Insurance Companies

WebsiteLinkedInAll Job Openings

1001 - 5000 employees

Founded 1911

🛡️ Insurance

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.

📋 Description

• Investigate and manage medical-only workers’ compensation claims across multiple jurisdictions • Verify coverage, deductibles, compensability, and applicable requirements • Communicate with insureds, injured employees, agents, and witnesses to gather information, explain the claims process, and provide status updates • Confirm return-to-work status and appropriate medical care • Use cost-containment resources and medical management referrals as needed • Establish appropriate reserves and maintain accurate claim documentation and follow-up schedules • Issue timely payments within assigned authority • Complete required state reporting and Medicare-related documentation • Prepare denial letters with manager approval • Promote nurse support, return-to-work, and preferred provider programs to insureds • Escalate claims when appropriate and prepare risk reports for Underwriting • Support fellow Claims team members • Stay current on medical treatment and workers’ compensation requirements

🎯 Requirements

• Associate degree or equivalent relevant experience • One year of insurance or claims handling experience or related experience • Iowa and Wisconsin medical-only workers’ compensation claims experience preferred • Adjuster licensing preferred through the candidate’s home state, where applicable, or Texas • Bachelor’s degree may be considered in lieu of the experience requirement • Attainment of all applicable state licenses within six months of hire • Basic knowledge of claims adjusting process preferred • Good knowledge of computers • Good investigative and problem-solving abilities • Ability to multi-task and prioritize deadlines • Strong organizational, written and verbal communication skills • Strong customer service skills • Ability to adhere to high standards of professional conduct and code of ethics • Ability to maintain confidentiality

🏖️ Benefits

• Comprehensive rewards package; benefits details provided at www.emcins.com/careers • Work from home anywhere in the United States • Continuing education to maintain required licenses

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