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EMC Insurance Companies
EMC Insurance Companies
1,001 – 5,000 Employees
Insurance
EMC Insurance Companies is a mutual insurance provider serving businesses through commercial property, liability, workers’ compensation, and business owners’ insurance. The company works with local agents to develop coverage suited to each policyholder’s needs, supported by risk management and loss control resources. Its business is centered on specialized commercial protection, close agent partnerships, and responsive service for organizations preparing for operational and financial risks.
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Senior Workers' Compensation Claims Adjuster

Manage complex workers' compensation claims for EMC Insurance Companies, from investigation through resolution. Assess coverage and reserves, negotiate settlements, and coordinate with clients and other stakeholders.

USUnited States
$78,726 – $119,646 / year
RemoteFull-timeSeniorEnglish RequiredClaims Specialist

Description

  • Manage moderately to highly complex workers' compensation claims from investigation through resolution.
  • Review coverage and determine whether losses are covered under client policies.
  • Contact clients, claimants, employees, and medical providers within 24 hours.
  • Investigate claim facts and obtain recorded statements.
  • Create and carry out plans to resolve claims efficiently.
  • Set and maintain reserves in line with client guidelines.
  • Review medical records and bills to assess injuries, compensability, treatment, and accuracy.
  • Identify risk factors and refer claims for specialized handling, including SIU, subrogation, and medical review.
  • Investigate and pursue subrogation opportunities.
  • Escalate complex claims and work with leadership on their handling.
  • Prepare required filings for the relevant jurisdictions.
  • Assess coverage, liability, and claim value, and respond to stakeholder questions.
  • Negotiate settlements, take part in mediation, and manage payments within authorized limits.
  • Prepare denial and settlement documents, and support litigation, mediation, arbitration, and Medicare compliance.
  • Maintain diaries and action plans; update claims; consult with clients; coordinate vendors; and manage reporting.
  • Keep current with regulations and maintain licenses and continuing education credits.
  • Help train and mentor team members.

Requirements

  • Bachelor's degree or equivalent relevant experience.
  • Five years of claims adjusting or related experience.
  • Experience with a third-party administrator (TPA) is preferred.
  • INS, AIC, SCLA, WCLA, or CPCU coursework or designation is preferred.
  • Workers' compensation claims adjusting experience in IA, MN, NE, SD, IN, KS, MO, WI, or IL is preferred.
  • Strong knowledge of claims theory and practice.
  • Strong analytical, investigative, and problem-solving skills for assessing liability and coverage.
  • Thorough knowledge of insurance contracts, medical terminology, and legal procedures affecting liability.
  • Strong computer skills, including experience with claims systems.
  • Strong organizational, written, and verbal communication skills, including documentation.
  • Ability to advise, partner with, and consult diverse internal and external stakeholders.
  • Occasional travel is required.
  • Valid driver's license and an acceptable motor vehicle report under company standards.

Benefits

  • Comprehensive rewards package; benefit details are available at www.emcins.com/careers.
  • Remote work from home anywhere in the United States.
  • Tobacco-free workplaces and company vehicles.

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