Remote Senior Workers' Comp Claims Adjuster

EMC Insurance Companies; North Carolina; Remote; USD 79,000 - 120,000; Full time

Job summary

EMC Insurance Companies is seeking an experienced workers’ compensation claim professional to own moderately to highly complex claims from investigation to resolution. You will set reserves, assess liability and coverage, and negotiate settlements while mentoring teammates and ensuring regulatory compliance.

In this role, you’ll build strong client relationships, escalate complex cases, and collaborate with leadership to improve outcomes.

Qualifications

• Bachelor’s degree or equivalent relevant experience.
• Five years of claims adjusting experience or related experience.
• Experience with a third party administrator (TPA) preferred.
• INS, AIC, SCLA, WCLA and CPCU coursework or designation preferred.
• Workers' compensation claims adjusting experience within the following jurisdictions preferred: FL, GA, NC, SC.

Responsibilities

• Analyzes coverage to confirm losses are covered under client policies.
• Initiates contact within 24 hours with all relevant parties (clients, claimants, employees, medical providers).
• Conducts thorough investigations, including fact-finding and recorded statements.
• Develops and executes action plans to resolve claims efficiently.
• Performs reserve analysis and sets/maintains appropriate reserves per client guidelines.
• Reviews medical records and bills to assess injury, compensability, treatment, and accuracy.
• Identifies risk factors and routes claims for specialized handling with approval.
• Identifies, investigates, and pursues subrogation opportunities, including review of official reports.
• Escalates complex claims and collaborates with leadership as needed.
• Prepares required jurisdictional filings for workers’ compensation claims.
• Evaluates coverage, liability, and claim value; responds to stakeholder inquiries.
• Negotiates settlements, participates in mediation, and manages payments within authority limits; recommends higher-value settlements.

Skills

Analytical & investigative abilities

Liability and coverage analysis

Strong communication skills

Negotiation and mediation

Regulatory compliance knowledge

Education

Bachelor’s degree

Five years of claims adjusting experience

CPCU or related designation

Tools

Claims software

Claims systems

Job description

EMC Insurance Companies is seeking an experienced workers’ compensation claim professional to own moderately to highly complex claims from investigation to resolution. You will set reserves, assess liability and coverage, and negotiate settlements while mentoring teammates and ensuring regulatory compliance.

In this role, you’ll build strong client relationships, escalate complex cases, and collaborate with leadership to improve outcomes.