Medical Only Claims Representative

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

Job summary

EMC Insurance is seeking a diligent claims professional to manage medical-only workers’ compensation claims across multiple jurisdictions. You will verify coverage, handle reserves, and maintain timely documentation with ongoing communication to insureds and providers.

The role emphasizes continued licensing, knowledge of claims processes, and strong customer service. A remote work arrangement within the United States is supported, with salary aligned to location and experience.

Qualifications

• Associate degree or equivalent relevant experience.
• One year of insurance or claims handling 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; good knowledge of computers.
• Strong investigative, problem-solving, and multi-tasking abilities.
• Strong organizational, written and verbal communication skills; strong customer service.
• Ability to maintain confidentiality and adhere to professional conduct.

Responsibilities

• Investigates and manages medical-only workers’ compensation claims across jurisdictions.
• Communicates with insureds, injured employees, agents, and witnesses to gather information and provide status.
• Establishes reserves, maintains claim documentation and follow-up schedules, and issues timely payments.
• Completes required state reporting and Medicare-related documentation; prepares denial letters with manager approval.
• Promotes nurse support, return-to-work, and preferred provider programs.
• Escalates claims when appropriate and supports fellow Claims team members.
• Stays current on medical treatment and workers’ compensation requirements; maintains required licenses.

Skills

Claims adjusting knowledge

Investigative skills

Customer service

Communication skills

Problem-solving

Multitasking

Organization

Confidentiality

Licensing knowledge

Education

Associate degree or equivalent relevant experience

Bachelor's degree may be considered in lieu of experience

Tools

Computers / IT literacy

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 #LI-DNI #LI-DNP

Hiring Salary Range

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, including relevant 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. All of our locations are tobacco free including in company vehicles. Why should you choose to apply for a position at EMC? We can give you plenty of reasons why EMC is a great place to work: More than 105 years of financial strength and stability Named a five-star insurance carrier by Insurance Business America Two-time recipient of the Best Practices Award of Excellence from the Independent Agents & Brokers of America Multiple locations recognized as Top Workplaces based solely on team member feedback Corporate culture that engages and empowers team members to achieve their best Outstanding benefits with life, medical, dental, vision and prescription drug coverage Competitive paid time off plan and a full day of volunteer time off annually Financial incentives, including a 401(k) plan match, pension plan, OneEMC bonus plan and recognition and anniversary awards Professional development and growth opportunities, including tuition reimbursement Wellness initiatives to improve team member well-being and reduce health insurance costs Flexibility to dress for your day and opportunities for alternative work arrangements EMC complies with labor law requirements. View the federal and e-verify labor law posters. Notice at Collection Privacy Policy (EMCC) – California Consumer Privacy Notice (EMCNL) – California Consumer Privacy Notice