Sobre este puesto de Senior Claims Adjuster (Workers' Compensation) en EMC Insurance
At EMC, we’re all about working together to make an impact. As part of our team, you’ll have the opportunity to grow, contribute, and gain experience that matters. We strive to be caring leaders, close partners, and responsive experts—always supporting each other to do our best work. Join us, and let’s improve lives together.
**This position is eligible to work from home anywhere in the United States**
In this role, you’ll have the opportunity to take ownership of moderately to highly complex workers' compensation claims and make a direct impact on outcomes for clients and claimants. You’ll drive investigations, evaluate coverage and liability, and shape claim strategies from start to resolution—balancing thoughtful analysis with decisive action. Your expertise will be key in setting reserves, negotiating fair settlements, and identifying risk and recovery opportunities. Along the way, you’ll build strong relationships with clients and stakeholders, ensure compliance with evolving regulations, and play a meaningful role in mentoring others and elevating team performance.
Essential Functions:
Analyzes coverage to confirm losses are covered under client policies
Initiates contact within 24 hours with all relevant parties (clients, claimants, employees, medical providers)
Conducts thorough investigations, including fact-finding and recorded statements
Develops and executes action plans to resolve claims efficiently
Performs reserve analysis and sets/maintains appropriate reserves per client guidelines
Reviews medical records and bills to assess injury, compensability, treatment, and accuracy
Identifies risk factors and routes claims for specialized handling (SIU, subrogation, medical review) with approval
Identifies, investigates, and pursues subrogation opportunities, including review of official reports
Escalates complex claims and collaborates with leadership as needed
Prepares required jurisdictional filings for workers’ compensation claims
Evaluates coverage, liability, and claim value; responds to stakeholder inquiries
Negotiates settlements, participates in mediation, and manages payments within authority limits; recommends higher-value settlements
Prepares and issues denial and settlement documentation; develops evaluation ranges and supports litigation, mediation, arbitration, and Medicare compliance
Maintains diaries and action plans, provides timely responses and claim updates, conducts client consultations, coordinates vendor resources, manages reporting (including excess carriers), stays current on regulations, maintains licenses/CEUs, and supports training of team members
Education & Experience:
Bachelor’s degree or equivalent relevant experience
Five years of claims adjusting experience or related experience
Prior experience with a third party administrator (TPA) preferred
INS, AIC, SCLA, WCLA and CPCU coursework or designation preferred
Workers' compensation claims adjusting experience within the following jurisdictions preferred: IA, MN, NE, SD & IN or IA, KS, MO, WI, IL
Knowledge, Skills, & Abilities:
Excellent knowledge of the theory and practice of the claim function
Excellent analytical, investigative and problem-solving abilities with respect to liability and coverage
Thorough knowledge of insurance contracts, medical terminology and legal aspects of court procedures affecting legal liability for all lines of insurance.
Strong computer skills, including claims systems
Strong organizational, written, and verbal communication skills, including documentation
Strong ability to advise, partner, and effectively consult with diverse internal and external stakeholders
Occasional travel required; a valid driver’s license with an acceptable motor vehicle report per company standards
The hiring salary range for this position will vary based on geographic location, falling within either of the following:
$78,726 - $108,771 or $87,008 - $119,646A hiring range represents a subset of the full salary range. The actual salary will depend on several factors, including relevant education, skills, and experience of an applicant, geographic location, and business needs.
For information relating to the benefits EMC Team Members receive as part of a comprehensive rewards package, please visit www.emcins.com/careers.
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.
