[Remote] Claims Representative

Note: The job is a remote job and is open to candidates in USA. EMC Insurance Companies is dedicated to 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 Workers' compensation claims handling experience strongly preferred 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 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 EMC Insurance is a top insurer based on net written premium, and we have more than 2,200 employees. It was founded in 1911, and is headquartered in Des Moines, Iowa, USA, with a workforce of 1001-5000 employees. Its website is