Claims Specialist

EMC Insurance Companies; United States; Remote; USD 86,000 - 130,000; Full time

Benefits offered by this job

Life insurance

Medical coverage

Dental coverage

Vision coverage

401(k) match

Pension plan

Tuition reimbursement

Wellness programs

Flexible work arrangements

Job summary

EMC Insurance is seeking an experienced Claims Adjuster to manage complex, multi-state claims across general liability and workers’ compensation. You will review coverage, gather statements, evaluate medical and loss information, and develop effective resolution strategies.

The role requires strong analytical, investigative, and communication skills, with experience in adjusting across Iowa, Arizona, and Utah. Prior TPA exposure and CPCU/INS designations are preferred.

Qualifications

• Bachelor’s degree or equivalent relevant experience.
• Seven years of claims adjusting experience or related experience.
• Must have adjusters experience in Iowa, Arizona, and Utah.
• Adjusters experience in Texas is preferred.
• Prior experience with a third party administrator (TPA) preferred.
• INS, AIC, SCLA, WCLA and CPCU designation preferred.

Responsibilities

• Investigates and manages complex, multi-line and multi-state claims.
• Reviews coverage, investigates facts of loss, evaluates information, and develops resolutions.
• Establishes reserves and maintains claim documentation.
• Evaluates coverage and settlement exposure and communicates decisions.
• Identifies subrogation opportunities and coordinates referrals.
• Negotiates and resolves complex claims within authority.
• Partners with defense counsel on litigated claims and guides litigation strategies.
• Maintains compliance with state reporting and other requirements.
• Builds client relationships through communication and file reviews.
• Analyzes claim and settlement trends.
• Maintains licenses and continuing education.
• Serves as a technical resource to Claims team.

Skills

Claims practices

Analytical skills

Investigative skills

Communication skills

Insurance contracts

Computer skills

Organizational skills

Risk assessment

Education

Bachelor’s degree or equivalent

Tools

Claims systems

Job description

Essential Functions

• Investigates and manages complex, multi-line and multi-state claims, including general liability and workers’ compensation losses.
• Reviews coverage, investigates facts of loss, obtains statements, evaluates medical and loss information, and develops effective claim resolution strategies.
• Establishes appropriate reserves and maintains accurate, timely claim documentation in accordance with client handling requirements.
• Evaluates coverage, liability, compensability, damages, and settlement exposure and communicates claim decisions to appropriate parties.
• Identifies and pursues subrogation opportunities and coordinates referrals to specialized resources, including Special Investigation, Medical Review, and other appropriate teams.
• Negotiates and resolves complex claims within assigned authority, including preparing claim evaluations, settlement ranges, denial correspondence, and settlement documentation.
• Partners with defense counsel on litigated claims and provides clients with guidance regarding litigation and resolution strategies.
• Maintains compliance with applicable state reporting, Medicare, excess carrier, and other claim-related requirements.
• Builds strong client relationships through responsive communication, consultation, file reviews, claim summaries, and coordination of appropriate resources.
• Analyzes claim and settlement trends to identify opportunities and support client needs.
• Maintains required professional licenses and continuing education while staying current on jurisdictional and industry developments.
• Serves as a technical resource to Claims team members, providing guidance on coverage, compensability, investigations, and claim strategy.

EDUCATION & EXPERIENCE

• Bachelor’s degree or equivalent relevant experience
• Seven years of claims adjusting experience or related experience
• Must have adjusters experience in Iowa, Arizona, and Utah
• Adjusters experience in Texas is preferred
• Prior experience with a third party administrator (TPA) preferred
• INS, AIC, SCLA, WCLA and CPCU designation preferred

KNOWLEDGE, SKILLS & ABILITIES

• Advanced knowledge of best claims practices used to resolve the serious and complex injury and worker’s compensation, general liability, property and auto commercial claims
• Excellent knowledge of the claim function
• Advanced analytical, investigative, and problem‑solving abilities with liability and coverage
• Excellent knowledge of insurance contracts, medical terminology and legal aspects of court procedures affecting legal liability for all lines of insurance
• Advanced computer skills, including claims systems
• Exceptional organizational, written and verbal communication skills, including documentation
• Thorough investigative and problem‑solving abilities
• Excellent ability to advise, partner, and effectively consult with diverse internal and external stakeholders
• Occasional travel required

Salary and Benefits

• The hiring salary range for this position will vary based on geographic location, falling within either of the following: $85,799 - $118,545 or $94,826 - $130,394
• A 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.
• EMC Team Members receive as part of a comprehensive rewards package benefits including life, medical, dental, vision and prescription drug coverage.
• Competitive paid time off plan and a full day of volunteer time off annually.
• Financial incentives, including a 401(k) plan match, pension plan, OneEMC bonus plan and recognition and anniversary awards.
• Professional development and growth opportunities, including tuition reimbursement.
• Wellness initiatives to improve team member well-being and reduce health insurance costs.
• Flexibility to dress for your day and opportunities for alternative work arrangements.

Equal Opportunity Employment

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.

Other Information

All of our locations are tobacco free including in company vehicles.

Why should you choose to apply for a position at EMC? We can give you plenty of reasons why EMC is a great place to work:

• More than 105 years of financial strength and stability
• Named a five-star insurance carrier by Insurance Business America
• Two-time recipient of the Best Practices Award of Excellence from the Independent Agents & Brokers of America
• Multiple locations recognized as Top Workplaces based solely on team member feedback
• Corporate culture that engages and empowers team members to achieve their best
• Outstanding benefits with life, medical, dental, vision and prescription drug coverage
• Competitive paid time off plan and a full day of volunteer time off annually
• Financial incentives, including a 401(k) plan match, pension plan, OneEMC bonus plan and recognition and anniversary awards
• Professional development and growth opportunities, including tuition reimbursement
• Wellness initiatives to improve team member well-being and reduce health insurance costs
• Flexibility to dress for your day and opportunities for alternative work arrangements

Additional Resources

EMC complies with labor law requirements. View the federal and e‑verify labor law posters.

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