Remote Senior Workers' Comp Claims Investigator & Negotiator

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

Job summary

EMC Insurance Companies is seeking a skilled workers’ compensation claims adjuster who will own moderately to highly complex claims from investigation through resolution. You’ll drive coverage analysis, set reserves, and negotiate settlements while maintaining client relationships and regulatory compliance.

The role emphasizes timely investigations, documentation, and collaboration with leadership to elevate team performance across GA, FL, NC, and SC markets. Remote work options available.

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 within GA/FL/NC/SC 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.
• Escalates complex claims and collaborates with leadership as needed.

Skills

Analytical skills

Investigative abilities

Communication skills

Insurance knowledge

Claims process knowledge

Education

Bachelor's degree

Tools

Claims systems

Job description

EMC Insurance Companies is seeking a skilled workers’ compensation claims adjuster who will own moderately to highly complex claims from investigation through resolution. You’ll drive coverage analysis, set reserves, and negotiate settlements while maintaining client relationships and regulatory compliance.

The role emphasizes timely investigations, documentation, and collaboration with leadership to elevate team performance across GA, FL, NC, and SC markets. Remote work options available.