Remote Workers' Comp Claims Leader | Senior Adjuster

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

Job summary

EMC Insurance Companies is seeking a skilled claims professional to own moderately to highly complex workers' compensation claims, driving investigations, evaluating coverage and liability, and shaping claim strategies from start to resolution with thoughtful analysis and decisive action.

You’ll set reserves, pursue subrogation when appropriate, and collaborate with leadership to elevate team performance while ensuring regulatory compliance and timely updates to stakeholders.

Qualifications

• Bachelor’s degree or equivalent relevant experience.
• Five years of claims adjusting 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 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 (SIU, subrogation, medical review) 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.
• 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, coordinates vendor resources, manages reporting (including excess carriers), stays current on regulations, maintains licenses/CEUs, and supports training of team members.

Skills

Analytical skills

Investigative skills

Problem-solving

Communication

Education

Bachelor’s degree

Five years claims adjusting experience

TPA experience

Industry coursework (INS/AIC/SCLA/WCLA/CPCU)

State-specific WC experience (FL/GA/NC/SC)

Tools

Claims systems

Job description

EMC Insurance Companies is seeking a skilled claims professional to own moderately to highly complex workers' compensation claims, driving investigations, evaluating coverage and liability, and shaping claim strategies from start to resolution with thoughtful analysis and decisive action.

You’ll set reserves, pursue subrogation when appropriate, and collaborate with leadership to elevate team performance while ensuring regulatory compliance and timely updates to stakeholders.