Claims Representative

EMC Insurance Companies

2d • Remote

About The Position

At EMC, we’re all about working together to make an impact. As part of our team, you’ll have the opportunity to grow, contribute, and gain experience that matters. We strive to be caring leaders, close partners, and responsive experts—always supporting each other to do our best work. Join us, and let’s improve lives together. This position can be performed remotely for candidates who reside in Iowa; candidates residing outside of Iowa will not be considered at this time Essential Functions:

Requirements

• 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

Nice To Haves

• 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

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

Benefits

• More than 105 years of financial strength and stability
• Named a five-star insurance carrier by Insurance Business America
• Two-time recipient of the Best Practices Award of Excellence from the Independent Agents & Brokers of America
• Multiple locations recognized as Top Workplaces based solely on team member feedback
• Corporate culture that engages and empowers team members to achieve their best
• Outstanding benefits with life, medical, dental, vision and prescription drug coverage
• Competitive paid time off plan and a full day of volunteer time off annually
• Financial incentives, including a 401(k) plan match, pension plan, OneEMC bonus plan and recognition and anniversary awards
• Professional development and growth opportunities, including tuition reimbursement
• Wellness initiatives to improve team member well-being and reduce health insurance costs
• Flexibility to dress for your day and opportunities for alternative work arrangements

What This Job Offers

• Job Type: Full-time
• Career Level: Entry Level
• Education Level: Associate degree