Remote Medical-Only Claims Specialist

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

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.