Medical Only Claims Representative

EMC Insurance Companies; Oregon; Hybrid; USD 47,000 - 71,000; Full time

Job summary

EMC Insurance Companies is seeking a claims professional to manage medical-only workers’ compensation claims across jurisdictions. You will verify coverage, communicate with insureds and witnesses, and manage return-to-work programs and cost-containment resources.

You'll handle reserve setting, documentation, and timely payments while staying current on regulatory requirements and licensure. Flexible remote work is available across the United States.

Qualifications

• Experience in insurance or claims handling is preferred or related field.
• Ability to obtain state licenses within six months of hire.
• Bachelor’s degree may substitute for some experience.
• Strong written and verbal communication and attention to detail.

Responsibilities

• Investigates and manages medical-only workers’ compensation claims across jurisdictions.
• Communicates with insureds, employees, agents, and witnesses to gather information and provide updates.
• Verifies coverage, deductibles, and required documentation; prepares denials with approval.
• Establishes reserves, documents claims, and processes payments within authority.
• Stays current on medical treatment and workers’ comp requirements; supports risk reporting.

Skills

Communication skills

Organizational skills

Customer service

Problem solving

Multi-tasking

Education

Associate degree or equivalent experience

Bachelor's degree considered

Licenses within six months

Tools

Computers

Job description

At EMC, we’re all about working together to make an impact. As part of our team, you’ll have the opportunity to grow, contribute, and gain experience that matters. We strive to be caring leaders, close partners, and responsive experts—always supporting each other to do our best work. Join us, and let’s improve lives together. This position is eligible to work from home anywhere in the United States

Essential Functions

Investigates and manages medical-only workers’ compensation claims across multiple jurisdictions, verifying coverage, deductibles, compensability, and applicable requirements. Communicates promptly with insureds, injured employees, agents, and witnesses to gather information, explain the claims process, and provide status updates. Confirms return-to-work status and appropriate medical care, using cost-containment resources and medical management referrals as needed. Establishes appropriate reserves, maintains accurate claim documentation and follow-up schedules, and issues timely payments within assigned authority. Completes required state reporting and Medicare-related documentation and prepares denial letters with manager approval. Promotes nurse support, return-to-work, and preferred provider programs to insureds. Escalates claims when appropriate, prepares risk reports for Underwriting, and supports fellow Claims team members. Stays current on medical treatment and workers’ compensation requirements and completes continuing education to maintain required licenses.

Education & Experience

• 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

Knowledge, Skills & Abilities

• 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

The hiring salary range for this position will vary based on geographic location, falling within either of the following: $46,990 - $64,911 or $51,927 - $71,385.

For information relating to the benefits EMC Team Members receive as part of a comprehensive rewards package, please visit www.emcins.com/careers.

Our employment practices are in accordance with the laws that prohibit discrimination due to race, color, creed, sex, sexual orientation, gender identity, genetic information, religion, age, national origin or ancestry, physical or mental disability, medical condition, veteran status, active military status, citizenship status, marital status or any other consideration made unlawful by federal, state, or local laws. All of our locations are tobacco free including in company vehicles.