Senior WC Claims Adjuster - Remote (CA)

EMC Insurance; California (MO); Hybrid; USD 79,000 - 120,000; Full time

Benefits offered by this job

401(k) plan match

Pension plan

OneEMC bonus plan

Tuition reimbursement

Wellness initiatives

Job summary

EMC Insurance is seeking 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, balancing analysis with decisive action.

Build relationships with clients and stakeholders while mentoring team members and ensuring regulatory compliance.

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 CA preferred

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

Investigation

Negotiation

Communication

Education

Bachelor's degree or equivalent

5 years claims adjusting experience

CA workers' compensation experience

INS, AIC, SCLA, WCLA and CPCU coursework or designation preferred

Tools

Claims systems

Job description

EMC Insurance is seeking 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, balancing analysis with decisive action.

Build relationships with clients and stakeholders while mentoring team members and ensuring regulatory compliance.