At EMC, you'll put your skills to good use as an important member of our team. You can count on gaining valuable experience while contributing to the company's success. EMC strives to hire and retain the best people by engaging, developing and rewarding employees.
**This position is eligible to work from home anywhere in the United States**
Summary:
Exercises independent judgment in the investigation, evaluation, negotiation, and disposition of 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.
Essential Functions:
Reviews the claim notice, contracts, state statutes, and policies to verify the appropriate coverage, deductibles, jurisdiction and compensability.
Initiates timely contact with insureds and claimants to explain the claims process
Obtains statements from insureds, injured workers, witnesses, and any other pertinent parties as appropriate
Documents claim activities, reserve analysis, summaries of reports in the claim system
Sets timely, adequate reserves in compliance with the company reserving philosophy and methodology
Identifies, investigates, and proactively pursues opportunities for recovery and subrogation
Researches medical treatment and diagnosis to gain understanding of claimant’s injury and medical history
Notifies all parties involved that legally require notice per jurisdictional requirements
Secures and reviews all necessary official reports, claim forms, video and documents
Reviews medical bills, invoices, and receipts for appropriateness and accuracy
Notifies the Claims Supervisor of claims requiring reassignment to a more appropriate level of claim handler
Gathers payment data to calculate wage benefits due and pays accordingly through proper payment channels
Continues to monitor wage loss data for changes such as overtime, light duty, child-support liens, seasonal and contractual employment, raises, and annual state legislative reviews that impact wage reimbursement and adjustments
Coordinates return to work with medical providers, insured and claimants
Coordinates appropriate medical care, including use of appropriate cost containment techniques and resources
Maintains accurate and timely diaries on all files to bring claims to resolution
Assists with marketing and agency duties as needed
Drafts independent medical exam (IME) and denial letters with supervisor oversight when appropriate
Prepares settlement evaluations, negotiation ranges and target settlement numbers prior to negotiation
Investigates and resolves questions of compensability and communicates with all relevant parties to resolve coverage issues in a timely manner
Works with attorneys, attending mediations, settlement conferences etc. to resolve claims
Assists claims team members as needed in handling of claims
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
Education & Experience:
Bachelor’s degree or equivalent relevant experience
One year of workers’ compensation claims adjusting experience or related experience
Attainment of all applicable state licenses within one year of hire
Relevant insurance designations preferred
Knowledge, Skills & Abilities:
Working 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 organizational and written and verbal communication skills
Good investigative and problem-solving abilities
Occasional travel required; a valid driver’s license with an acceptable motor vehicle report per company standards required if driving
Per the Colorado Equal Pay for Equal Work Act, the hiring range for this position for Colorado-based team members is $58,618.44 - $75,262.27. The hiring range for other locations may vary.
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.
