Senior Claims Adjuster, Workers' Compensation

EMC Insurance Companies

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

Posted 9/28/2026full-timeRemote • California • 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 coverage analysis, negotiation, and compliance with legal and regulatory standards. Proficient in conducting thorough investigations, preparing documentation, and collaborating with stakeholders to ensure efficient claim resolution.

Highest-signal resume keywords

Workers' Compensation Claims AdjustingClaims InvestigationNegotiation SkillsAnalytical Problem-SolvingInsurance Contract Knowledge

ATS Keywords

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Applicant Tracking System Keywords

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Hard Skills

Claims AdjustingCoverage AnalysisReserve AnalysisMedical Record ReviewSubrogation InvestigationSettlement DocumentationJurisdictional FilingsClaims Systems ProficiencyRegulatory ComplianceDocumentation Preparation

Soft Skills

Organizational SkillsWritten CommunicationVerbal CommunicationStakeholder ConsultationMentoring

Certifications & Qualifications

Bachelor's DegreeINSAICSCLAWCLACPCU

Industry Keywords

Workers' CompensationThird Party Administrator (TPA)California Claims AdjustingMedical TerminologyLegal Liability

About the role

Key responsibilities & impact

Take ownership of moderately to highly complex workers’ compensation claims from start to resolution
Analyze coverage to confirm losses are covered under client policies
Initiate contact within 24 hours with relevant parties
Conduct fact-finding, recorded statements, and thorough claim investigations
Develop and execute action plans to resolve claims efficiently
Perform reserve analysis and set or maintain appropriate reserves
Review medical records and bills to assess injury, compensability, treatment, and accuracy
Identify risk factors and route claims for specialized handling
Investigate and pursue subrogation opportunities
Escalate complex claims and collaborate with leadership
Prepare required jurisdictional filings
Evaluate coverage, liability, and claim value
Negotiate settlements, participate in mediation, and manage payments within authority limits
Prepare denial and settlement documentation and support litigation, mediation, arbitration, and Medicare compliance
Maintain diaries and action plans, provide claim updates, conduct client consultations, coordinate vendor resources, and manage reporting
Stay current on regulations, maintain licenses/CEUs, support team training, mentor others, and elevate team performance

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 California 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 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 consult with diverse internal and external stakeholders
Occasional travel required
Valid driver’s license with an acceptable motor vehicle report per company standards
Ability to maintain licenses/CEUs

Benefits

Comp & perks

Comprehensive rewards package
Remote work from home anywhere in the state of California
Occasional travel
Tobacco-free workplaces and company vehicles