Medical Only Claims Representative

EMC Insurance Companies

. Investigate and manage medical-only workers’ compensation claims across multiple jurisdictions .

Posted 10/30/2026full-timeRemote • United StatesJunior💰 $46,990 - $71,385 per yearWebsite

Core Competencies

Role fit

Core Competencies

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Demonstrates expertise in managing medical-only workers’ compensation claims, including verifying coverage, communicating effectively with stakeholders, and maintaining accurate documentation. Proficient in claims adjusting processes and committed to high standards of professional conduct and customer service.

Highest-signal resume keywords

Medical-Only Workers’ Compensation Claims ManagementClaims Adjusting Process KnowledgeStrong Organizational SkillsEffective Communication SkillsCustomer Service Skills

ATS Keywords

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Applicant Tracking System Keywords

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Hard Skills

Claims Handling ExperienceInvestigative AbilitiesProblem-Solving SkillsDocumentation ManagementCost-Containment Resources Usage

Soft Skills

Multi-Tasking AbilityPrioritization SkillsConfidentiality Maintenance

Tools & Technologies

Computer Proficiency

Certifications & Qualifications

Adjuster LicensingState Licenses Attainment

Industry Keywords

Workers’ CompensationMedical Management ReferralsReturn-To-Work ProgramsState ReportingMedicare-Related Documentation

About the role

Key responsibilities & impact

Investigate and manage medical-only workers’ compensation claims across multiple jurisdictions
Verify coverage, deductibles, compensability, and applicable requirements
Communicate with insureds, injured employees, agents, and witnesses to gather information, explain the claims process, and provide status updates
Confirm return-to-work status and appropriate medical care
Use cost-containment resources and medical management referrals as needed
Establish appropriate reserves and maintain accurate claim documentation and follow-up schedules
Issue timely payments within assigned authority
Complete required state reporting and Medicare-related documentation
Prepare denial letters with manager approval
Promote nurse support, return-to-work, and preferred provider programs to insureds
Escalate claims when appropriate and prepare risk reports for Underwriting
Support fellow Claims team members
Stay current on medical treatment and workers’ compensation requirements

Requirements

What you’ll need

Associate degree or equivalent relevant experience
One year of insurance or claims handling experience or related experience
Iowa and Wisconsin medical-only workers’ compensation claims experience preferred
Adjuster licensing preferred through the candidate’s home state, where applicable, or Texas
Bachelor’s degree may be considered in lieu of the experience requirement
Attainment of all applicable state licenses within six months of hire
Basic knowledge of claims adjusting process preferred
Good knowledge of computers
Good investigative and problem-solving abilities
Ability to multi-task and prioritize deadlines
Strong organizational, written and verbal communication skills
Strong customer service skills
Ability to adhere to high standards of professional conduct and code of ethics
Ability to maintain confidentiality

Benefits

Comp & perks

Comprehensive rewards package; benefits details provided at www.emcins.com/careers
Work from home anywhere in the United States
Continuing education to maintain required licenses