Workers' Compensation Claims Adjuster I
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.
**Position is eligible to work from home anywhere in the US**
Essential Functions:
Independently investigates, evaluates, negotiates, and resolves workers’ compensation claims within authority guidelines; communicates with insureds, agents, and partners on coverage, status, and inquiries
Investigates and evaluates claims, verifying coverage, jurisdiction, and compensability
Initiates timely contact with insureds, claimants, and relevant parties to explain the claims process
Gathers statements, documentation, and official reports; documents all file activity and updates claim records
Sets and adjusts reserves in line with company guidelines
Reviews medical treatment, billing, and wage data to determine appropriate benefits and payments
Coordinates medical care and return-to-work efforts
Identifies and pursues subrogation and recovery opportunities
Ensures timely statutory notifications and compliance with jurisdictional requirements
Monitors claim progress and escalates complex claims as needed
Prepares settlement evaluations, strategies, and negotiation targets
Investigates and resolves compensability and coverage issues
Negotiates settlements and collaborates with attorneys; attends mediations and conferences as needed
Issues settlement documentation and payments within authority limits
Provides clear, timely claim status updates to insureds, agents, and claimants
Ensures compliance with all state reporting and documentation requirements
Collaborates with internal teams (SIU, Subrogation, Medical, etc.) and supports team members
Submits referrals and promotes programs such as return-to-work and preferred provider networks
Assists with account servicing and marketing efforts as needed
Maintains licenses/CEUs and completes ongoing training on regulatory and medical updates
Education & Experience:
Bachelor’s degree or equivalent relevant experience
One year of workers’ compensation claims adjusting experience or related experience
Attainment of all applicable state licenses within one year of hire
Relevant insurance designations preferred
Knowledge, Skills & Abilities:
Working knowledge of the theory and practice of the claim function
Good knowledge of insurance contracts, medical terminology and substantive and procedural laws
Ability to adhere to high standards of professional conduct and code of ethics
Strong knowledge of computers and claims systems
Strong organizational and written and verbal communication skills
Good investigative and problem-solving abilities
Occasional travel required; a valid driver’s license with an acceptable motor vehicle report per company standards required if driving
The hiring salary range for this position will vary based on geographic location, falling within either of the following:
$55,795 - $77,098 or $61,659 - $84,778A 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.
Apply To This Job
**Position is eligible to work from home anywhere in the US**
Essential Functions:
Independently investigates, evaluates, negotiates, and resolves workers’ compensation claims within authority guidelines; communicates with insureds, agents, and partners on coverage, status, and inquiries
Investigates and evaluates claims, verifying coverage, jurisdiction, and compensability
Initiates timely contact with insureds, claimants, and relevant parties to explain the claims process
Gathers statements, documentation, and official reports; documents all file activity and updates claim records
Sets and adjusts reserves in line with company guidelines
Reviews medical treatment, billing, and wage data to determine appropriate benefits and payments
Coordinates medical care and return-to-work efforts
Identifies and pursues subrogation and recovery opportunities
Ensures timely statutory notifications and compliance with jurisdictional requirements
Monitors claim progress and escalates complex claims as needed
Prepares settlement evaluations, strategies, and negotiation targets
Investigates and resolves compensability and coverage issues
Negotiates settlements and collaborates with attorneys; attends mediations and conferences as needed
Issues settlement documentation and payments within authority limits
Provides clear, timely claim status updates to insureds, agents, and claimants
Ensures compliance with all state reporting and documentation requirements
Collaborates with internal teams (SIU, Subrogation, Medical, etc.) and supports team members
Submits referrals and promotes programs such as return-to-work and preferred provider networks
Assists with account servicing and marketing efforts as needed
Maintains licenses/CEUs and completes ongoing training on regulatory and medical updates
Education & Experience:
Bachelor’s degree or equivalent relevant experience
One year of workers’ compensation claims adjusting experience or related experience
Attainment of all applicable state licenses within one year of hire
Relevant insurance designations preferred
Knowledge, Skills & Abilities:
Working knowledge of the theory and practice of the claim function
Good knowledge of insurance contracts, medical terminology and substantive and procedural laws
Ability to adhere to high standards of professional conduct and code of ethics
Strong knowledge of computers and claims systems
Strong organizational and written and verbal communication skills
Good investigative and problem-solving abilities
Occasional travel required; a valid driver’s license with an acceptable motor vehicle report per company standards required if driving
The hiring salary range for this position will vary based on geographic location, falling within either of the following:
$55,795 - $77,098 or $61,659 - $84,778A 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.
Apply To This Job