- Serves as a subject matter expert for compensability, medical analysis/financial impact questions, and claim handling procedures. Collaborates with WC claim team to review claims and collaborates on resolution strategies
- Maintains a caseload of diaries for major files to consult on and resolve escalated WC issues
- Provides reserve and settlement authority for cases exceeding regional authority
- Represents the WC claims department when addressing escalated WC claim issues
- Prepares for and routinely participates in regional roundtables.
- Prepares conference reports on individual claims for discussion and provides proper notice of cases discussed and ensures action is taken by file handler
- Works closely with other teams including Claims Legal, Medical Case Review, Analytics, SIU, Marketing, Underwriting, Actuary, and external vendors to resolve WC claim handling and/or contractual issues, identify and resolve issues, and gain alignment on WC claims strategies
- Validates claims data and reviews multiple sources of data to assist in making good claim decisions. Provides input, insight, and trend analysis by reviewing and analyzing claim data for claim leadership
- Makes recommendations for educational opportunities and training for WC team members to ensure consistency within the entire department. Conducts training as appropriate
- Provides technical expertise and input on reserve recommendations to the WC claims leadership
- Assists with early identification of Catastrophic cases to evaluate the need for outside Medical Management vendors to utilize their specialized medical expertise and cost-savings programs. Oversees files and vendors through case progression
- Reviews files audited by claim supervisors to assist with calibration, accuracy, and consistency
- Assists with marketing and implementation of large accounts, ongoing servicing, and reporting issues through the policy term
- Serves as point person to identify opportunities for improvement and monitor progress on claim audit action plans implemented by claims teams, and works closely with teams to improve. Reports subsequent progress to claim leadership
- Works with the Audit team and Claims Directors to provide ongoing support for WC claim handling, including compliance with claim best practices, reserving philosophy, guidelines, and litigation handling guidelines
- Serves as the point person to monitor progress on workers' compensation claims wide audit action plan items implemented by the Workers' Compensation Claims leadership and works closely with teams to report to the workers' compensation claims AVP's
- Reviews and evaluates allocated and unallocated expenses for assigned claim region.
- Monitors existing and proposed legislation, court decisions and trends pertaining to issues that could impact EMC's handling of WC claims.
- Participates in evaluation of vendors and new technology impacting the industry
- Serves as a subject matter expert on WC technical tools, marketing tools, and state reporting requirements including EDI and manual filings
- Advises and collaborates with WC Claims leadership on approaches to positively enhance customer interactions and reduce undesirable experiences
- Leads and/or participates in corporate claims projects.
- Develops and fosters relationships within claims, underwriting, and marketing teams to educate agents and accounts on claim services offered by EMC as well as ensure agents receive superior customer experiences and select EMC as their insurer of choice.
- Collaborates with Corporate Office Underwriting, Actuary and Marketing departments to track line of business development and review opportunities for improvement.
- Bachelor's degree or equivalent relevant experience
- Ten years of workers' compensation claims handling experience in progressively responsible roles, including prior experience with large loss claims
- Attainment of all applicable state licenses as required
- Insurance designations, such as AIC, CIC, AIM and CPCU preferred
- Superior knowledge of the theory and practice of the workers' compensation claim function
- Superior knowledge of property insurance contracts, construction and weather terminology, as well as policy conditions and court procedures regarding disputes on loss value or coverage
- Excellent knowledge of insurance contracts, and legal aspects of court procedures affecting legal liability for property line of insurance
- Superior organizational and written and verbal communication skills
- Superior investigative and problem-solving abilities
- Excellent leadership qualities
- Excellent knowledge of applicable computer software and claims systems
- Occasional travel; a valid driver's license with an acceptable motor vehicle report per company standards required if driving
-
Casualty Claims Consultant
3 weeks ago
EMC Insurance Des Moines, United StatesAt 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 posit ...
-
Complex Property Claims Consultant
3 weeks ago
Capstone Search Group Inc Des Moines, United States[vc_row][vc_column][vc_custom_heading text="About the Role" font_container="tag:h3|font_size:26px|text_align:left|line_height:24px" google_fonts="font_family:Lato%3A100%2C100italic%2C300%2C300italic%2Cregular%2Citalic%2C700%2C700italic%2C900%2C900italic|font_style:700%20bold%20re ...
-
Complex Claims Consultant
2 weeks ago
Berkley Urbandale, United StatesCompany Details: · Continental Western Group is a regional property casualty insurance company that offers commercial products and services through independent agents in the Midwest. With a culture that focuses on innovation and inclusion, CWG has been rated as a Best Place to W ...
-
Complex Claims Consultant
3 weeks ago
Berkley Urbandale, United StatesCompany Details: · Continental Western Group is a regional property casualty insurance company that offers commercial products and services through independent agents in the Midwest. With a culture that focuses on innovation and inclusion, CWG has been rated as a Best Place to W ...
-
Claims Consultant, PC
5 days ago
Holmes Murphy & Associates Waukee, United StatesAbout Us: · Have you thought how rewarding it would be to use your knowledge and experience to help clients improve their claim process and outcomes? Do you enjoy helping clients and solving problems? If that sounds like you, consider joining our team · Holmes Murphy is one of ...
-
Claims Consultant, PC
3 weeks ago
Holmes Murphy & Associates Waukee, United StatesAbout Us: · Have you thought how rewarding it would be to use your knowledge and experience to help clients improve their claim process and outcomes? Do you enjoy helping clients and solving problems? If that sounds like you, consider joining our team · Holmes Murphy is one of ...
-
Adjuster, Property Insurance Claims
1 week ago
Elevate Claims Solutions Des Moines, IA, United StatesElevate Claims Solutions is founded on the belief that human experience and claim quality are the essence of profitable growth and retention for our adjuster partners, our clients, and ourselves. Are you ready, willing, and able to Elevate? · Elevate Claims Solutions is seeking a ...
-
Disability Claims Manager
3 weeks ago
The Principal Financial Group Des Moines, United StatesDo you have strong disability claims and change leadership experience? Are you passionate about mentoring and development of others? As a Disability Claims Manager in our Life & DI Claims area, youll lead a team of Claims Analyst and Consultants ens Claims Manager, Manager, Claim ...
-
Legal EEO Counsel
2 weeks ago
WELLS FARGO BANK Des Moines, United States Full timeAbout this role: · Wells Fargo is seeking a Legal EEO Counsel join the Employment Division of the Wells Fargo Legal Department. For additional information on this line of business, refer to the external Careers Site at · In this role, you will:Analyze and respond to legal claims ...
-
Unemployment Claim Specialist
3 weeks ago
Equifax Des Moines, United StatesAs an Unemployment Claims Specialist you will be tasked with receiving, analyzing and building claims for states and Unemployment Insurance Consultants.What youll doAnalyze unemployment claims and questionnaires via SIDES, state websites, and scanned mail copy. (20%)Determine bes ...
-
Unemployment Claim Specialist
3 weeks ago
Equifax Des Moines, United StatesAs an Unemployment Claims Specialist you will be tasked with receiving, analyzing and building claims for states and Unemployment Insurance Consultants. · What you'll do · Analyze unemployment claims and questionnaires via SIDES, state websites, and scanned mail copy. (20%) · De ...
-
Internal Medicine
2 weeks ago
Global Medical Staffing Des Moines, United States Full timeInternal Medicine physician job in Iowa : Global Medical Staffing - To get this new telehealth adventure started, pick up the phone and call us today.Willing to wait for license · BC required · Weekdays, Weekends, Days, Swings · 4 - 6 consults per hour · Must be able to see patie ...
-
Internal Medicine
2 weeks ago
Global Medical Staffing Des Moines, United States Full timeInternal Medicine physician employment in Iowa : Global Medical Staffing - To get this new telehealth adventure started, pick up the phone and call us today.Willing to wait for license · BC required · Weekdays, Weekends, Days, Swings · 4 - 6 consults per hour · Must be able to se ...
-
Part Time Remote Licensed Psychologist
1 week ago
Rula Health Des Moines, United States Part timeJob Description · About Rula · Rula is a comprehensive behavioral health solution that makes it easy for individuals, couples, and families to find the right provider covered by their health insurance. We are deeply committed to providing high-quality care that improves the lives ...
-
Part Time Remote Licensed Psychologist
4 days ago
Rula Health Des Moines, United States Part timeAbout Rula · Rula is a comprehensive behavioral health solution that makes it easy for individuals, couples, and families to find the right provider covered by their health insurance. We are deeply committed to providing high-quality care that improves the lives of our clients, i ...
-
Corporate Compliance Lead
3 weeks ago
American Enterprise Group Des Moines, United StatesJOB SUMMARY · The Corporate Compliance Lead, Senior Compliance Analyst, or Compliance Analyst is responsible for managing or supporting our corporate compliance programs, including privacy and anti-money laundering (AML); researching and analyzing related legislation and regulat ...
-
Consultant, Program Underwriting
1 week ago
Nationwide Des Moines, United StatesConsultant, Program Underwriting - E&S/Specialty (Workers Compensation) page is loaded · Consultant, Program Underwriting - E&S/Specialty (Workers Compensation) · Apply · locations · Iowa - Des Moines · United States - Remote · time type · Full time · posted on · Posted ...
-
Workers' Compensation Programs Specialist
3 weeks ago
EMC Insurance Des Moines, United StatesAt 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 posit ...
-
Risk Consultant
2 weeks ago
Generis TEK Inc. Des Moines, United StatesWe have Contract role for Risk Consultant for our client Des Moines, IA. Please let me know if you or any of your friends would be interested in this position. · Position Details: · Risk Consultant- Des Moines, IA · Location : Des Moines, IA, Position is Hybrid - Will Require Bei ...
-
Senior Strategy Consultant
1 week ago
Zurich NA Des Moines, United StatesZurich NA · Senior Strategy Consultant · Des Moines , · Iowa · Apply Now · What can go right when you can grow your career? · Now is the time to move forward and make a difference. At Zurich, we want you to share your unique perspectives, experiences and ideas so we can grow ...
Workers' Compensation Claims Consultant - Des Moines, United States - EMC Insurance
Description
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** Essential Functions:
Education & Experience:
Knowledge, Skills & Abilities:
Per the Colorado Equal Pay for Equal Work Act, the hiring range for this position for Colorado-based team members is $119, $153, 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.
