Remote Senior Workers' Comp Claims Adjuster – CA

EMC Insurance Companies; Sacramento (CA); Remote; USD 79,000 - 120,000; Full time

Job summary

EMC Insurance Companies seeks an experienced Workers’ Compensation Claims Adjuster to take ownership of moderately to highly complex claims in California. You will drive investigations, evaluate coverage and liability, set reserves, and shape claim strategies from start to resolution while mentoring others and elevating team performance.

You will build relationships with clients and stakeholders, ensure regulatory compliance, and manage subrogation opportunities, settlements, and SIU involvement

Qualifications

• Bachelor’s degree or equivalent relevant experience.
• Five years of claims adjusting experience or related experience.
• Prior experience with a third party administrator (TPA) preferred.
• INS, AIC, SCLA, WCLA and CPCU coursework or designation preferred.
• Workers' compensation claims adjusting experience in CA preferred.

Responsibilities

• Analyzes coverage to confirm losses are covered under client policies.
• Initiates contact within 24 hours with all relevant parties.
• 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; recommend higher-value settlements.
• Prepares and issues denial and settlement documentation; develops evaluation ranges and supports litigation, mediation, arbitration, and Medicare compliance.
• Maintains diaries and action plans, provides timely responses and claim updates, conducts client consultations.

Skills

Analytical

Investigative

Problem-solving

Communication

Education

Bachelor's degree

CPCU coursework

Tools

Claims systems

Job description

EMC Insurance Companies seeks an experienced Workers’ Compensation Claims Adjuster to take ownership of moderately to highly complex claims in California. You will drive investigations, evaluate coverage and liability, set reserves, and shape claim strategies from start to resolution while mentoring others and elevating team performance.

You will build relationships with clients and stakeholders, ensure regulatory compliance, and manage subrogation opportunities, settlements, and SIU involvement