Senior Claims Adjuster – WC

EMC Insurance Companies

. Take ownership of moderately to highly complex workers’ compensation claims from investigation through resolution .

Posted 9/28/2026full-timeRemote • United StatesSenior💰 $78,726 - $119,646 per yearWebsite

Core Competencies

Role fit

Core Competencies

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Demonstrates expertise in managing complex workers' compensation claims, including investigation, negotiation, and compliance with legal and regulatory standards. Proficient in analyzing coverage, liability, and treatment while effectively communicating with diverse stakeholders.

Highest-signal resume keywords

Workers' Compensation Claims AdjustingClaims Investigation and ResolutionAnalytical and Problem-Solving SkillsInsurance Contracts KnowledgeStrong Communication Skills

ATS Keywords

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Applicant Tracking System Keywords

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Hard Skills

Claims AdjustingReserve AnalysisFact-FindingMedical Record ReviewSettlement NegotiationRisk RecoverySubrogationJurisdictional FilingsMediation ParticipationRegulatory Compliance

Soft Skills

Organizational SkillsWritten CommunicationVerbal CommunicationAdvisory SkillsMentoring

Tools & Technologies

Claims SystemsDocumentation Software

Certifications & Qualifications

Bachelor's DegreeINSAICSCLAWCLACPCU

Industry Keywords

Workers' CompensationThird Party AdministratorMedical TerminologyLegal LiabilityCourt Procedures

About the role

Key responsibilities & impact

Take ownership of moderately to highly complex workers’ compensation claims from investigation through resolution
Analyze coverage, liability, compensability, treatment, claim value, and policy applicability
Initiate contact with clients, claimants, employees, and medical providers within 24 hours
Conduct fact-finding, investigations, and recorded statements
Develop and execute action plans to resolve claims efficiently
Perform reserve analysis and set or maintain appropriate reserves
Review medical records and bills
Identify and pursue risk, recovery, and subrogation opportunities
Route claims for specialized handling, including SIU, subrogation, and medical review
Escalate complex claims and collaborate with leadership
Prepare jurisdictional filings, denial documentation, settlement documentation, and claim evaluations
Negotiate settlements, participate in mediation, and manage payments within authority limits
Support litigation, mediation, arbitration, and Medicare compliance
Maintain diaries and action plans, provide claim updates, conduct client consultations, coordinate vendors, and manage reporting
Stay current on regulations and maintain licenses and CEUs
Mentor and support training of team members

Requirements

What you’ll need

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 in FL, GA, NC, or SC preferred
Excellent knowledge of the theory and practice of the claim function
Excellent analytical, investigative, and problem-solving abilities regarding liability and coverage
Thorough knowledge of insurance contracts, medical terminology, and legal aspects of court procedures affecting legal liability
Strong computer skills, including claims systems
Strong organizational, written, and verbal communication skills, including documentation
Strong ability to advise, partner, and consult with diverse internal and external stakeholders
Valid driver’s license with an acceptable motor vehicle report per company standards

Benefits

Comp & perks

Comprehensive rewards package; benefits details provided at www.emcins.com/careers
Work from home
Occasional travel required
Tobacco-free workplaces and company vehicles