Remote Medical-Only Claims Specialist

EMC Insurance Companies; United States; Remote; USD 47.000 - 71.000; Vollzeit

Zusammenfassung

EMC Insurance Companies is seeking a Medical Only Claims Representative to manage medical-only workers' compensation claims nationwide from a home-based location in the United States.

The role emphasizes investigations, timely communications with insureds and witnesses, and adherence to state-specific requirements. Candidates should have an associate degree or equivalent, with at least one year in claims handling and relevant licensing pursued within six months of hire.

Qualifikationen

• 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.

Aufgaben

• 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.

Kenntnisse

Investigations

Communication

Problem-solving

Multi-tasking

Organization

Confidentiality

Customer service

Ausbildung

Associates degree or equivalent

Bachelor's degree may be considered

Tools

Computers

Jobbeschreibung

EMC Insurance Companies is seeking a Medical Only Claims Representative to manage medical-only workers' compensation claims nationwide from a home-based location in the United States.

The role emphasizes investigations, timely communications with insureds and witnesses, and adherence to state-specific requirements. Candidates should have an associate degree or equivalent, with at least one year in claims handling and relevant licensing pursued within six months of hire.