Note: The job is a remote job and is open to candidates in USA. EMC Insurance Companies is focused on 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
• 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
• Workers' compensation claims handling experience strongly preferred
• 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