Claims Representative

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:

• 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

Education & Experience:

• Associate degree or equivalent relevant experience

• One year of claims handling or insurance experience or related experience

• 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

Knowledge, Skills & Abilities:

• 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

The hiring salary range for this position will vary based on geographic location, falling within either of the following:

$46,990 - $64,911 or $51,927 - $71,385

A hiring range represents a subset of the full salary range. The actual salary will depend on several factors, including relevant education, skills, and experience of an applicant, geographic location, and business needs.

 

 

For information relating to the benefits EMC Team Members receive as part of a comprehensive rewards package, please visit www.emcins.com/careers.

Our employment practices are in accordance with the laws that prohibit discrimination due to race, color, creed, sex, sexual orientation, gender identity, genetic information, religion, age, national origin or ancestry, physical or mental disability, medical condition, veteran status, active military status, citizenship status, marital status or any other consideration made unlawful by federal, state, or local laws.

All of our locations are tobacco free including in company vehicles.