Remote Medical-Only Claims Specialist

emcins; United States; À distance; USD 47 000 - 71 000; Plein temps

Résumé du poste

EMC Insurance Companies is seeking a dedicated Claims Adjuster to manage medical-only workers' compensation claims across multiple jurisdictions, verify coverage, reserves, and payments with careful documentation.

This remote, nationwide role requires one year of claims handling, an associate degree, licensure within six months, and strong investigative and communication skills to deliver excellent customer service.

Qualifications

• Associate degree or equivalent relevant experience required.
• One year of insurance or claims handling experience preferred.
• State licenses within six months of hire where applicable.
• Bachelor's degree may be considered in lieu of experience.

Responsabilités

• Investigates and manages medical-only workers' compensation claims across multiple jurisdictions.
• Communicates with insureds, injured employees, agents, and witnesses to gather information and provide updates.
• Confirms return-to-work status and medical care, using cost-containment resources.
• Establishes reserves, maintains claim documentation, and issues timely payments within authority.
• Completes required state reporting and Medicare documentation; prepares denial letters with manager approval.
• Promotes nurse support and preferred provider programs to insureds.
• Escalates claims when appropriate and supports team members.
• Keeps current on medical treatment and workers' compensation requirements; completes continuing education.

Connaissances

Claims handling

Investigative skills

Communication skills

Multitasking

Customer service

Ethics / confidentiality

Formation

Associate degree or equivalent

One year claims experience

Licenses within home state within 6 months

Bachelor's degree may substitute experience

Description du poste

EMC Insurance Companies is seeking a dedicated Claims Adjuster to manage medical-only workers' compensation claims across multiple jurisdictions, verify coverage, reserves, and payments with careful documentation.

This remote, nationwide role requires one year of claims handling, an associate degree, licensure within six months, and strong investigative and communication skills to deliver excellent customer service.