Medical Only Claims Representative

EMC Insurance Companies; United States; Remote; USD 47,000 - 71,000; Full time

Job summary

EMC Insurance Companies is seeking a Claims Specialist to manage medical-only workers’ compensation claims across multiple jurisdictions. The role allows you to work from home anywhere in the United States and involves communicating with insureds, injured employees, agents, and witnesses, and ensuring timely processing.

You will establish reserves, maintain documentation, complete state reporting, and coordinate with medical providers and nurse support.

Qualifications

• Associate degree or equivalent relevant experience required.
• One year of insurance or claims handling experience.
• Licenses for applicable states must be attained within six months of hire.
• Iowa and Wisconsin medical-only WC claims experience preferred; adjuster licensing in home state or Texas.
• Bachelor’s degree may be considered in lieu of experience.

Responsibilities

• Investigates and manages medical-only workers’ compensation claims across multiple jurisdictions.
• Contacts insureds, injured employees, agents, and witnesses to gather info and provide updates.
• Verifies coverage, deductibles, and compensability and maintains required documentation.
• Establishes reserves and issues payments within authority.
• Completes state reporting and Medicare documentation; prepares denial letters with manager approval.
• Promotes nurse support, return-to-work and preferred provider programs.
• Escalates claims when appropriate and supports team members.
• Maintains licensure and completes continuing education.

Skills

Investigative skills

Problem-solving abilities

Communication skills

Customer service

Organizational skills

Confidentiality

Ethics

Education

Associate degree or equivalent

Bachelor's degree considered

State licenses within 6 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

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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

A hiring range represents a subset of the full salary range.The actual salary will depend on several factors, includingrelevant education, skills, and experience of an applicant, geographic location, and business needs.

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.

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