Medical Only Claims Representative

EMC Insurance Companies

7d • $46,990 - $71,385 • Remote

About The Position

The Medical Only Claims Representative investigates and manages medical-only workers’ compensation claims across multiple jurisdictions. The role verifies coverage, deductibles, compensability, and applicable requirements; communicates with insureds, injured employees, agents, and witnesses; and coordinates return-to-work status and appropriate medical care. The representative uses cost-containment resources and medical management referrals as needed, establishes reserves, maintains claim documentation and follow-up schedules, and issues timely payments within assigned authority. The position also completes state reporting and Medicare-related documentation, prepares denial letters for manager approval, promotes nurse support, return-to-work, and preferred provider programs, escalates claims when appropriate, prepares risk reports for Underwriting, and supports the Claims team. The representative stays current on medical treatment and workers’ compensation requirements and completes continuing education to maintain applicable licenses. The position is eligible to work from home anywhere in the United States.

Requirements

• Associate degree or equivalent relevant experience.
• One year of insurance or claims handling experience or related experience.
• Bachelor’s degree may be considered in lieu of the experience requirement.
• Attain all applicable state licenses within six months of hire.
• Good knowledge of computers.
• Good investigative and problem-solving abilities.
• Ability to multi-task and prioritize deadlines.
• Strong organizational, written, and verbal communication skills.
• Strong customer service skills.
• Ability to adhere to high standards of professional conduct and code of ethics.
• Ability to maintain confidentiality.

Nice To Haves

• Iowa and Wisconsin medical-only workers’ compensation claims experience preferred.
• Adjuster licensing preferred through the candidate’s home state, where applicable, or Texas.
• Basic knowledge of the claims adjusting process preferred.

Responsibilities

• Investigate and manage medical-only workers’ compensation claims across multiple jurisdictions, verifying coverage, deductibles, compensability, and applicable requirements.
• Communicate promptly with insureds, injured employees, agents, and witnesses to gather information, explain the claims process, and provide status updates.
• Confirm return-to-work status and appropriate medical care, using cost-containment resources and medical management referrals as needed.
• Establish appropriate reserves, maintain accurate claim documentation and follow-up schedules, and issue timely payments within assigned authority.
• Complete required state reporting and Medicare-related documentation and prepare denial letters with manager approval.
• Promote nurse support, return-to-work, and preferred provider programs to insureds.
• Escalate claims when appropriate, prepare risk reports for Underwriting, and support fellow Claims team members.
• Stay current on medical treatment and workers’ compensation requirements and complete continuing education to maintain required licenses.

What This Job Offers

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