EMC Insurance Companies · 4 days ago
Workers Compensation Claims Adjuster II
Iowa, United States
Full-time
Remote
Mid Level
$70K/yr - $89K/yr
3+ years exp
Maximize your interview chancesFinancial ServicesInsurance
Insider Connection @EMC Insurance Companies
Get 3x more responses when you reach out via email instead of LinkedIn.
Responsibilities
Exercises independent judgment in the investigation, evaluation, negotiation, and disposition of moderately complex workers’ compensation claims, within limitations of authority outlined in the Claims Guide.
Communicates with insureds, agents, and experts regarding coverage and claim status or questions.
Reviews and evaluates the claim notice, lawsuits, contracts, state statutes, and policies to verify the appropriate coverage, deductibles
Initiates timely contact with insureds and injured worker to explain the claims process, and begin investigation to determine compensability, and appropriate jurisdiction for the correct state statues.
Obtains statements as appropriate from insured, injured worker, witnesses, and all other pertinent parties
Secures appropriate video, pertinent evidence, and recommends hiring a field investigation or expert when appropriate
Documents claim activities, reserve analysis, summaries of reports in the claim system including Medicare (MSP) modules in the claims system.
Research medical treatment and diagnosis to gain understanding of claimant’s injury and medical history
Sets and monitors timely, adequate reserves in compliance with the company reserving philosophy and methodology throughout the life of the claim
Secures and reviews all necessary official reports, claim forms and documents, providing summaries of them to the claim file
Reviews bills, invoices, and receipts, including legal and litigation related expenses, for accuracy and appropriateness
Notifies all parties involved that legally require appropriate notice including but not limited to the state and other carriers as necessary.
Resolves questions of coverage, liability, and the value of the claims and communicates with insureds and claimants to resolve claims
Drafts and sends investigation letters and denial letters upon Supervisor approval
Provides prompt, detailed responses to agents, insureds, and claimants on the status of claims
Communicates with insured, claimants, and attorneys to negotiate the settlement of claims
Prepares settlement evaluations, negotiation ranges and target settlement numbers prior to negotiation
Determines and negotiates settlement amounts for resolution within assigned authority limits. Makes recommendations to management for settlement amounts outside of authority limits
Assists claims team members in handling of claims
Maintains continuing education credits and licenses current as required by jurisdiction
Submits referrals to the Special Investigation, Subrogation, external Medical Management, and internal Medical Review Units as Appropriate
Markets On Call Nurse (OCN), Return to Work (RTW), and Select Preferred Provider (SPP) programs to insured’s and identifies non-use for corrective measures
Prepares risk alerts for Underwriting and Risk Improvement
Qualification
Find out how your skills align with this job's requirements. If anything seems off, you can easily click on the tags to select or unselect skills to reflect your actual expertise.
Required
Bachelor’s degree or equivalent relevant experience
Three years of workers compensation claims adjusting experience or related experience
Attainment of all applicable state licenses within six months of hire
Strong knowledge of the theory and practice of the claim function
Good knowledge of insurance contracts, medical terminology and substantive and procedural laws
Ability to adhere to high standards of professional conduct and code of ethics
Strong knowledge of computers and claims systems
Strong written and verbal communication skills
Excellent customer service skills
Solid investigative and problem-solving abilities
Strong organizational abilities and empathetic interpersonal skills
Travel required; a valid driver’s license with an acceptable motor vehicle report per company standards required if driving
Preferred
Relevant insurance designations preferred
Company
EMC Insurance Companies
EMC Insurance Companies is among the top 60 insurance organizations in the country based on net written premium, and we have more than 2,500 employees.
1,001-5,000 employees
Funding
Current Stage
Public CompanyTotal Funding
unknown1982-02-12IPO· nasdaq:EMCI
Leadership Team
Matthew Spackman
Senior Vice President and Chief Human Resources Officer
P
Philip Lucca
Senior Vice President, Field Operations
Recent News
2024-04-11
Des Moines Register
2024-04-10
Company data provided by crunchbase
