Workers' Compensation Claims Adjuster I

EMC Insurance Companies; United States; Remote; USD 55,000 - 84,000; Full time

Benefits offered by this job

Life insurance

Medical coverage

Dental coverage

Vision coverage

Prescription drug coverage

401(k) plan match

Pension plan

Paid time off

Volunteer time off

Job summary

EMC Insurance is seeking an experienced workers’ compensation claims adjuster to review notices and determine coverage and compensability. You will conduct investigations, obtain statements, and document activity to move claims toward timely resolution.

The role supports collaboration with insureds, medical providers, and internal teams, including return-to-work coordination and subrogation opportunities where appropriate, with a nationwide work-from-home option.

Qualifications

• Bachelor’s degree or equivalent relevant experience.
• One year of workers’ compensation claims adjusting experience or related experience.
• Attainment of all applicable state licenses within one year of hire.
• Relevant insurance designations preferred.

Responsibilities

• Reviews claim notices, policies, contracts, and state requirements to determine coverage and compensability.
• Conducts timely claim investigations; contacts insureds, injured workers, witnesses, and relevant parties; obtains statements and reports.
• Documents claim activity, maintains diaries, establishes reserves, and ensures timely claim handling through resolution.
• Reviews medical records, treatment plans, bills, and other documents to evaluate injuries and coordinate medical care.
• Coordinates return-to-work efforts and communicates with involved parties.

Skills

Strong communication skills

Investigative skills

Organizational skills

Travel readiness

Education

Bachelor’s degree or equivalent

Tools

Claims systems

Job description

At EMC, we’re all about working together to make an impact. As part of our team, you’ll have the opportunity to grow, contribute, and gain experience that matters. We strive to be caring leaders, close partners, and responsive experts—always supporting each other to do our best work. Join us, and let’s improve lives together.

This position is eligible to work from home anywhere in the United States

Essential Functions

Reviews claim notices, policies, contracts, and applicable state requirements to determine coverage, jurisdiction, deductibles, and compensability.

Conducts timely claim investigations, including contacting insureds, injured workers, witnesses, and other relevant parties; obtaining statements; and securing necessary reports and documentation.

Documents claim activity, maintains accurate file diaries, establishes appropriate reserves, and ensures timely claim handling through resolution.

Reviews medical records, treatment plans, bills, invoices, and other documentation to understand injuries, evaluate expenses, and coordinate appropriate medical care.

Calculates and administers wage benefits while monitoring changes that may affect benefit amounts.

Coordinates return-to-work efforts with injured workers, insureds, medical providers, and other appropriate parties.

Identifies and pursues recovery and subrogation opportunities and refers claims to specialized resources, including Special Investigation and medical management or review teams, when appropriate.

Investigates and resolves compensability and coverage issues and communicates decisions and claim status to relevant parties.

Prepares settlement evaluations, negotiation strategies, independent medical examination (IME) documentation, and denial correspondence as appropriate.

Partners with attorneys and participates in mediations, settlement conferences, and other activities to facilitate claim resolution.

Promotes appropriate claims programs and resources, including On Call Nurse (OCN), Return to Work (RTW), and Select Preferred Provider (SPP) programs.

Collaborates with Claims, Underwriting, Risk Improvement, and other internal teams, including preparing risk alerts and supporting broader claims initiatives as needed.

Education & Experience

Bachelor’s degree or equivalent relevant experience

One year of workers’ compensation claims adjusting experience or related experience

Experience with Oklahoma, Kansas, Arkansas, and Kentucky preferred.

Attainment of all applicable state licenses within one year of hire

Relevant insurance designations preferred

Knowledge, Skills & Abilities

Working knowledge of the theory and practice of the claim function

Good knowledge of insurance contracts, medical terminology and substantive and procedural laws

Ability to adhere to high standards of professional conduct and code of ethics

Strong knowledge of computers and claims systems

Strong organizational and written and verbal communication skills

Good investigative and problem-solving abilities

Occasional travel required; a valid driver’s license with an acceptable motor vehicle report per company standards required if driving

The hiring salary range for this position will vary based on geographic location, falling within either the $54,566-$75,194 range or the $60,168-$82,916 range.

A hiring range represents a subset of the full salary range.

The actual salary will depend on several factors, including relevant education, skills, and experience of an applicant, geographic location, and business needs.

The hiring salary range for this position will vary based on geographic location, falling within either of the following: $55,795 - $77,098 or $61,659 - $84,778

A hiring range represents a subset of the full salary range.

The actual salary will depend on several factors, including relevant education, skills, and experience of an applicant, geographic location, and business needs.

For information relating to the benefits EMC Team Members receive as part of a comprehensive rewards package, please visit www.emcins.com/careers.

Our employment practices are in accordance with the laws that prohibit discrimination due to race, color, creed, sex, sexual orientation, gender identity, genetic information, religion, age, national origin or ancestry, physical or mental disability, medical condition, veteran status, active military status, citizenship status, marital status or any other consideration made unlawful by federal, state, or local laws.

All of our locations are tobacco free including in company vehicles.

Why should you choose to apply for a position at EMC?

More than 105 years of financial strength and stability

Named a five-star insurance carrier by Insurance Business America

Two-time recipient of the Best Practices Award of Excellence from the Independent Agents & Brokers of America

Multiple locations recognized as Top Workplaces based solely on team member feedback

Corporate culture that engages and empowers team members to achieve their best

Outstanding benefits with life, medical, dental, vision and prescription drug coverage

Competitive paid time off plan and a full day of volunteer time off annually

Financial incentives, including a 401(k) plan match, pension plan, OneEMC bonus plan and recognition and anniversary awards

Professional development and growth opportunities, including tuition reimbursement

Wellness initiatives to improve team member well-being and reduce health insurance costs

Flexibility to dress for your day and opportunities for alternative work arrangements

EMC complies with labor law requirements.

View the federal and e-verify labor law posters.

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