Job Overview
Location
Remote in US
Job Type
Full-time
Category
DevOps
Date Posted
June 3, 2026
Full Job Description
đź“‹ Description
- • Analyze insurance coverage to confirm losses are covered under client policies for workers' compensation claims
- • Initiate contact with clients, claimants, employees, and medical providers within 24 hours of claim assignment
- • Conduct thorough investigations including fact-finding, recorded statements, and review of official reports
- • Develop and execute action plans to resolve moderately to highly complex workers' compensation claims efficiently
- • Perform reserve analysis and set/maintain appropriate reserves in alignment with client guidelines
- • Review medical records and bills to assess injury compensability, treatment necessity, and billing accuracy
- • Identify risk factors and route claims for specialized handling such as SIU, subrogation, or medical review with proper approval
- • Investigate and pursue subrogation opportunities by analyzing accident reports and legal documentation
- • Escalate complex claims to leadership and collaborate on resolution strategies
- • Prepare and file required jurisdictional workers' compensation claim documentation
- • Evaluate coverage, liability, and claim value; respond to stakeholder inquiries with clarity and precision
- • Negotiate settlements, participate in mediation, and manage payments within authorized limits; recommend higher-value settlements when appropriate
- • Prepare and issue denial and settlement documentation; develop evaluation ranges to support litigation, mediation, arbitration, and Medicare compliance
- • Maintain accurate diaries and action plans, provide timely claim updates, and conduct regular client consultations
- • Coordinate vendor resources including medical providers, attorneys, and third-party administrators
- • Manage reporting requirements for excess carriers and ensure compliance with evolving state and federal regulations
- • Maintain active professional licenses and complete continuing education units (CEUs) as required
- • Support training and mentoring of junior claims adjusters to elevate team performance and consistency
🎯 Requirements
- • 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, or CPCU coursework or designation preferred
- • Workers' compensation claims adjusting experience in IA, IL, WI, or KS jurisdictions preferred
- • Valid driver’s license with an acceptable motor vehicle report per company standards
🏖️ Benefits
- • Comprehensive rewards package including health, retirement, and paid time off (details available at www.emcins.com/careers)
- • Salary range of $78,726–$119,646 based on geographic location and experience
- • Opportunities for professional development and licensure support
- • Tobacco-free workplace including company vehicles
Skills & Technologies
About EMC Insurance Companies
EMC Insurance Companies is a leading provider of commercial insurance, offering a comprehensive range of products and services to businesses of all sizes. With a strong focus on customer service and risk management, EMC partners with independent agents to deliver tailored solutions that meet the unique needs of each client. Their offerings include property, casualty, workers' compensation, and umbrella insurance, backed by a commitment to financial strength and stability. EMC is dedicated to helping businesses protect their assets, manage risks effectively, and achieve their growth objectives through reliable insurance coverage and expert guidance. They strive to be a trusted advisor and partner in their clients' success.
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