Workers' Compensation Enhanced Medical Only Representative
About The Position
The Enhanced Medical Only (EMO) role is a workers' compensation claims representative position. You will be responsible for handling low complexity claims that are first party and classified as medical only. In this position, you will use skills in investigation, evaluation, and negotiation to resolve claims. Communication skills will also be applied to correspond in writing and over the phone with individuals including injured workers, insureds, agents, vendors, team members, and defense counsel. The EMO role is an important step to building knowledge and skills and may support room for future growth and career pathing potential within the Workers' Compensation Department!
Requirements
- College degree or equivalent experience preferred.
- 1-2 years of previous claims experience preferred but not required; professional customer service experience is beneficial.
- Licensing Required to obtain your license(s) as an adjuster in the state(s) in which you are assigned to adjust claims.
- Licensing must be obtained within the timeframe set forth by the Company and must be maintained as needed throughout your employment.
Responsibilities
- Receive and set up claims assignments from the insured First Notice of Loss reports.
- Review incoming loss notices and assign accordingly to claim representatives within the unit or send to the appropriate regional claim office.
- Investigate first party, low severity Workers’ Compensation medical claims.
- Confirm compensability & coverage
- Communicate directly with the insured’s, medical providers, agents, and vendors by telephone and in writing.
- Review and approve medical treatments and associated medical bills.
- Maintain strict diary on all active files.
- Follow directives and instructions from Claims Supervisors and superiors.
- Adhere to the WC Claims Best Practices, Workers’ Compensation statutes, bulletins, and attend company training classes.
- Provide exceptional customer service.
- Adhere to mandated state regulations.
- Operate within a rules-based environment with a strong customer satisfaction emphasis.
- Perform other tasks as assigned by management in relation to daily operations.
- Monitor and update Medicare reporting.
Benefits
- Medical and Prescription Drug Benefit
- Dental Benefit
- Vision Benefit
- Life Insurance and Disability Benefits
- 401(k) Profit Sharing and Investment Plan (Includes annual Company financial contribution and discretionary Profit Sharing contribution based upon annual company financial results)
- Health Savings Account (HSA)
- Flexible Spending Accounts
- Tuition Assistance, Training, and Professional Designations
- Company-Paid Family Leave
- Adoption/Surrogacy Assistance Benefit
- Voluntary Benefits - Group Accident Insurance, Hospital Indemnity, Critical Illness, Legal, ID Theft Protection, Pet Insurance
- Student Loan Refinancing Services
- Care.com Membership with Back-up Care, Senior Solutions
- Business Travel Accident Insurance
- Matching Gifts program
- Paid Volunteer Day
- Employee Referral Award Program
- Wellness programs
- Personal insurance discount
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What This Job Offers
Job Type
Full-time
Career Level
Entry Level
Education Level
Associate degree
