Workers' Compensation Claims Adjuster I

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.

• *Position is eligible to work from home anywhere in the US**

Essential Functions:
Independently investigates, evaluates, negotiates, and resolves workers’ compensation claims within authority guidelines; communicates with insureds, agents, and partners on coverage, status, and inquiries

Investigates and evaluates claims, verifying coverage, jurisdiction, and compensability

Initiates timely contact with insureds, claimants, and relevant parties to explain the claims process

Gathers statements, documentation, and official reports; documents all file activity and updates claim records

Sets and adjusts reserves in line with company guidelines

Reviews medical treatment, billing, and wage data to determine appropriate benefits and payments

Coordinates medical care and return-to-work efforts

Identifies and pursues subrogation and recovery opportunities

Ensures timely statutory notifications and compliance with jurisdictional requirements

Monitors claim progress and escalates complex claims as needed

Prepares settlement evaluations, strategies, and negotiation targets

Investigates and resolves compensability and coverage issues

Negotiates settlements and collaborates with attorneys; attends mediations and conferences as needed

Issues settlement documentation and payments within authority limits

Provides clear, timely claim status updates to insureds, agents, and claimants

Ensures compliance with all state reporting and documentation requirements

Collaborates with internal teams (SIU, Subrogation, Medical, etc.) and supports team members

Submits referrals and promotes programs such as return-to-work and preferred provider networks

Assists with account servicing and marketing efforts as needed

Maintains licenses/CEUs and completes ongoing training on regulatory and medical updates

Education & Experience:
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

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 of the following:
$55,795 - $77,098 or $61,659 - $84,778A 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.

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