EMC Insurance Companies

1 001 – 5 000 Darbuotojai

EMC Insurance Companies yra savitarpio draudimo bendrovė, teikianti įmonėms komercinio turto, civilinės atsakomybės, darbuotojų kompensavimo ir verslo savininkų draudimo paslaugas. Bendrovė bendradarbiauja su vietos draudimo agentais, kad sukurtų kiekvieno draudėjo poreikius atitinkančią apsaugą, kurią papildo rizikos valdymo ir nuostolių prevencijos ištekliai. Jos veikla grindžiama specializuota komercine apsauga, glaudžia partneryste su agentais ir operatyviu aptarnavimu organizacijoms, besirengiančioms veiklos ir finansinėms rizikoms.

Darbai įmonėje

Senior Workers' Compensation Claims Adjuster

Manage complex workers' compensation claims for EMC Insurance Companies, from investigation through resolution. Assess coverage and reserves, negotiate settlements, and coordinate with clients and other stakeholders.

prieš 2 savaites

Jungtinės Valstijos

78 726 $ – 119 646 $ / metai

Nuotolinis Visas etatas Vyresnysis specialistas Privaloma Kalba: anglų Draudimo žalų specialistas

Aprašymas

Manage moderately to highly complex workers' compensation claims from investigation through resolution.
Review coverage and determine whether losses are covered under client policies.
Contact clients, claimants, employees, and medical providers within 24 hours.
Investigate claim facts and obtain recorded statements.
Create and carry out plans to resolve claims efficiently.
Set and maintain reserves in line with client guidelines.
Review medical records and bills to assess injuries, compensability, treatment, and accuracy.
Identify risk factors and refer claims for specialized handling, including SIU, subrogation, and medical review.
Investigate and pursue subrogation opportunities.
Escalate complex claims and work with leadership on their handling.
Prepare required filings for the relevant jurisdictions.
Assess coverage, liability, and claim value, and respond to stakeholder questions.
Negotiate settlements, take part in mediation, and manage payments within authorized limits.
Prepare denial and settlement documents, and support litigation, mediation, arbitration, and Medicare compliance.
Maintain diaries and action plans; update claims; consult with clients; coordinate vendors; and manage reporting.
Keep current with regulations and maintain licenses and continuing education credits.
Help train and mentor team members.

Reikalavimai

Bachelor's degree or equivalent relevant experience.
Five years of claims adjusting or related experience.
Experience with a third-party administrator (TPA) is preferred.
INS, AIC, SCLA, WCLA, or CPCU coursework or designation is preferred.
Workers' compensation claims adjusting experience in IA, MN, NE, SD, IN, KS, MO, WI, or IL is preferred.
Strong knowledge of claims theory and practice.
Strong analytical, investigative, and problem-solving skills for assessing liability and coverage.
Thorough knowledge of insurance contracts, medical terminology, and legal procedures affecting liability.
Strong computer skills, including experience with claims systems.
Strong organizational, written, and verbal communication skills, including documentation.
Ability to advise, partner with, and consult diverse internal and external stakeholders.
Occasional travel is required.
Valid driver's license and an acceptable motor vehicle report under company standards.

Privalumai

Comprehensive rewards package; benefit details are available at www.emcins.com/careers.
Remote work from home anywhere in the United States.
Tobacco-free workplaces and company vehicles.

Susiję darbai

201 – 500 Darbuotojai

Bankininkystė Finansai Fintech

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Nuotolinis Visas etatas Vidutinis lygis Vyresnysis specialistas Privaloma Kalba: anglų Draudimo žalų specialistas

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