Remote Senior Workers' Comp Claims Adjuster

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

Job summary

EMC Insurance seeks an experienced workers' compensation claims professional to own moderately to highly complex claims, drive investigations, set reserves, and pursue recovery opportunities. You will analyze coverage, liability, and case value while mentoring teammates and ensuring regulatory compliance.

The role emphasizes collaboration with clients, claimants, and providers, with responsibilities across subrogation, medical reviews, and litigation support; strong analytical, communication,

Qualifications

• Bachelor’s degree or equivalent experience.
• Five years of claims adjusting or related experience.
• Experience with workers’ compensation claims and TPAs preferred.
• Jurisdictional experience in FL, GA, NC, SC is a plus.

Responsibilities

• Analyze coverage to confirm losses are covered under client policies.
• Initiate contact within 24 hours with all relevant parties.
• Conduct thorough investigations and fact-finding.
• Develop action plans to resolve claims efficiently.
• Perform reserve analysis and set appropriate reserves.
• Review medical records and bills for injury and treatment.
• Identify and pursue subrogation opportunities.
• Escalate complex claims and collaborate with leadership.
• Prepare filings and support litigation or mediation as needed.

Skills

Claims investigations

Reserving

Subrogation

Negotiation

Regulatory compliance

Analytical thinking

Client communication

Mentoring

Travel readiness

Education

Bachelor’s degree or equivalent

Tools

Claims systems

MS Office

Job description

EMC Insurance seeks an experienced workers' compensation claims professional to own moderately to highly complex claims, drive investigations, set reserves, and pursue recovery opportunities. You will analyze coverage, liability, and case value while mentoring teammates and ensuring regulatory compliance.

The role emphasizes collaboration with clients, claimants, and providers, with responsibilities across subrogation, medical reviews, and litigation support; strong analytical, communication,