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Posted: 9/19/2026Senior Claims Adjuster – Workers' Compensation
EMC Insurance CompaniesCore Competencies
Role fitCore Competencies
Use this summary to align your resume positioning with the role.
Demonstrates expertise in managing workers' compensation claims from investigation to resolution, with strong analytical and problem-solving skills to assess liability and coverage. Proficient in stakeholder communication and negotiation, ensuring compliance with regulations and effective claims management.
Highest-signal resume keywords
Workers' Compensation Claims AdjustingClaims Investigation and ResolutionAnalytical and Problem-Solving SkillsInsurance Contracts KnowledgeStakeholder Communication
About the role
Key responsibilities & impact- Take ownership of moderately to highly complex workers' compensation claims from investigation through resolution
- Analyze coverage and confirm losses are covered under client policies
- Initiate contact within 24 hours with clients, claimants, employees, and medical providers
- Conduct fact-finding investigations and obtain recorded statements
- Develop and execute action plans to resolve claims efficiently
- Analyze and maintain appropriate reserves according to client guidelines
- Review medical records and bills to assess injury, compensability, treatment, and accuracy
- Identify risk factors and route claims for specialized handling, including SIU, subrogation, and medical review
- Investigate and pursue subrogation opportunities
- Escalate complex claims and collaborate with leadership
- Prepare required jurisdictional filings
- Evaluate coverage, liability, and claim value and respond to stakeholder inquiries
- 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 vendors, and manage reporting
- Stay current on regulations and maintain licenses/CEUs
- Support training and mentor 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 IA, MN, NE, SD, IN, KS, MO, WI, or IL 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
- Occasional travel required
- Valid driver’s license with an acceptable motor vehicle report per company standards
Benefits
Comp & perks- Comprehensive rewards package; benefits details provided via www.emcins.com/careers
- Remote work from home anywhere in the United States
- Tobacco-free workplaces and company vehicles
ATS Keywords
✓ Tailor your resumeApplicant Tracking System Keywords
Tip: use these terms in your resume and cover letter to boost ATS matches.
Hard Skills
Claims AdjustingFact-Finding InvestigationsCoverage AnalysisMedical Record ReviewSettlement NegotiationClaims Systems ProficiencyRisk AssessmentJurisdictional FilingsSubrogation PursuitAction Plan Development
Soft Skills
Organizational SkillsWritten CommunicationVerbal CommunicationAdvisory SkillsMentoring
Certifications & Qualifications
Bachelor’s DegreeINSAICSCLAWCLACPCU
Industry Keywords
Workers' CompensationThird Party Administrator (TPA)Medical TerminologyLegal LiabilityInsurance Regulations