Medical Only Claims Representative

This is a fully remote position, open to applicants in United States.

📋 Description

• Conduct investigations and manage medical-only workers’ compensation claims across various jurisdictions.

• Verify coverage details, deductibles, compensability, and relevant requirements.

• Engage with insured individuals, injured employees, agents, and witnesses to collect information, clarify the claims process, and provide updates on claim status.

• Confirm return-to-work status and ensure appropriate medical care is provided.

• Utilize cost-containment resources and make medical management referrals as necessary.

• Set appropriate reserves while maintaining accurate documentation of claims and follow-up schedules.

• Process timely payments within the limits of assigned authority.

• Complete all necessary state reporting and Medicare-related documentation.

• Draft denial letters with the approval of a manager.

• Advocate for nurse support, return-to-work initiatives, and preferred provider programs to insured parties.

• Escalate claims when necessary and prepare risk reports for the Underwriting team.

• Collaborate and support fellow Claims team members.

• Stay updated on medical treatments and workers’ compensation regulations.

⛳️ Requirements

• Associate degree or equivalent relevant experience is required.

• At least one year of experience in insurance or claims handling, or a related field.

• Experience with Iowa and Wisconsin medical-only workers’ compensation claims is preferred.

• Adjuster licensing is preferred in the candidate’s home state, where applicable, or in Texas.

• A Bachelor’s degree may be accepted in place of the experience requirement.

• Must obtain all necessary state licenses within six months of employment.

• Basic knowledge of the claims adjusting process is preferred.

• Proficient computer skills are required.

• Strong investigative and problem-solving skills.

• Ability to manage multiple tasks and prioritize deadlines effectively.

• Excellent organizational, written, and verbal communication skills.

• Exceptional customer service abilities.

• Commitment to high standards of professional conduct and ethical guidelines.

• Capacity to maintain confidentiality at all times.

🏝️ Benefits

• Comprehensive rewards package; details about benefits can be found at www.emcins.com/careers.

• Opportunity to work from home from anywhere in the United States.

• Continuing education provided to maintain required licenses.