Workers' Compensation Claims Adjuster I

EMC Insurance Companies; United States; Remote; USD 60,000 - 85,000; Full time

Job summary

EMC Insurance Companies is seeking a remote Workers’ Compensation Claims Adjuster who can review notices and contracts to determine coverage and jurisdictions. You will conduct investigations, gather statements, and document activity to support timely claim resolution.

The role requires a bachelor’s degree or equivalent experience and at least one year in workers’ compensation claims adjusting, with preferred licenses and designations.

Qualifications

• Bachelor’s degree or equivalent relevant experience required.
• One year of workers’ compensation claims adjusting experience or related experience preferred.
• Experience with Oklahoma, Kansas, Arkansas, and Kentucky preferred.
• Attainment of all applicable state licenses within one year of hire.
• Relevant insurance designations preferred.

Responsibilities

• 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.

Skills

Claims knowledge

Communication skills

Organizational skills

Investigative abilities

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.