Note: The job is a remote job and is open to candidates in USA. EMC Insurance Companies is dedicated to making an impact through teamwork and support. They are seeking a Claims Representative to analyze coverage, manage worker’s compensation claims, and ensure timely communication with clients and medical providers.
Responsibilities
- Analyzes coverage to ensure loss is covered by client policy
- Initiates contact within 24-hours for employees, clients and medical providers for worker’s compensation claims
- Takes statements over the phone from insureds, claimants, and/or witnesses and resolves questions on liability and the value of claims
- Sets timely, adequate reserves to cover probable company and client exposure
- Secures authorization to obtain medical bills and reports, as well as requests records from medical providers
- Reviews bills, invoices and receipts for accuracy
- Drafts information for state filings for workers’ compensation claims, if requested
- Prepares excess carrier notifications as needed
- Investigates subrogation and recovery potential on every claim which includes review of police and fire department reports and pursues accordingly
- Notifies people leader of complex claims that require escalation for additional expertise in handling
- Anticipate customer needs, communicates decisions, defines expectations and fulfills commitments to involved parties
- Maintains active diaries and plans of action
- Promptly responds to all inquires
- Refers requests for account inquires to Claims Management
- Prepares claims summary reports for clients and participates in file reviews per client handling instructions
- Responds to questions from clients, agents, claimants, lawyers or coworkers
- Reviews questions of coverage, liability and the value of claims and losses, with supervisory approval
- Drafts and sends denial letters upon people leader approval
- Negotiates settlement amounts for damages claimed within assigned authority limits
- Makes recommendations to management for settlement amounts outside of authority limits, and follows case to conclusion for training purposes as appropriate
- Issues payments within check authority limit
- Remains current on jurisdictional and industry related developments within the respective line of business through internal and external training opportunities
Skills
- Associate degree or equivalent relevant experience
- One year of claims handling or insurance experience or related experience
- Workers' compensation claims handling experience strongly preferred
- Basic knowledge of the claims adjusting process
- Basic knowledge of insurance contracts, medical terminology and legal aspects of court procedures affecting legal liability for all lines of insurance
- Good knowledge of computers, including claims systems
- Strong organizational and written and verbal communication skills, including documentation
- Good investigative and problem-solving abilities
- Bachelor's degree may be considered in lieu of the claim handling or insurance experience requirement
- AIC, INS or other insurance related certifications preferred
Company Overview
- EMC Insurance is a top insurer based on net written premium, and we have more than 2,200 employees. It was founded in 1911, and is headquartered in Des Moines, Iowa, USA, with a workforce of 1001-5000 employees. Its website is http://www.emcins.com/.