Claims Representative

EMC Insurance Companies

1d•$46,990 - $71,385•Remote

About The Position

This position is eligible to work from home anywhere in the US. As a Claims Representative, you'll play a key role in helping clients navigate the claims process by investigating, evaluating, and resolving low-complexity third-party auto, casualty, and premises liability claims. You'll be the primary point of contact for insureds, claimants, and clients, gathering facts, assessing coverage and liability, and delivering fair, timely claim resolutions. Working closely with experienced claims professionals, you'll develop your expertise in claim investigations, negotiations, and customer service while helping EMC deliver exceptional outcomes for its clients. Your ability to build relationships, communicate effectively, and make sound decisions will have a direct impact on customer satisfaction, claim resolution, and overall business results.

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

Low-complexity third-party auto, casualty, and premises liability 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

Investigate and evaluate low-complexity third-party auto, casualty, and premises liability claims, including coverage analysis and liability assessment.
Initiate timely contact with insureds, claimants, witnesses, clients, and other involved parties, typically within 24 hours of claim assignment.
Obtain statements, gather documentation, review police/fire reports, and identify subrogation or recovery opportunities.
Establish and maintain appropriate claim reserves based on exposure and claim developments.
Secure and review medical records, bills, invoices, receipts, and other supporting documentation for accuracy and claim evaluation.
Prepare excess carrier notifications and escalate complex claims to leadership when additional expertise is required.
Respond to inquiries from clients, agents, claimants, attorneys, and coworkers regarding claim status, coverage, liability, and damages.
Draft reservation of rights and denial letters, with appropriate management approval.
Negotiate and resolve claims within assigned authority, recommend settlements exceeding authority limits, and issue payments accordingly.
Prepare bodily injury and property damage evaluations, settlement documentation, and ensure proper execution of releases and agreements.
Maintain active claim diaries, adhere to client-specific handling instructions, prepare claim summaries and reports, participate in file reviews, and stay current on industry and jurisdictional developments through ongoing training.