Senior Claims Adjuster Workers' Compensation

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**

In this role, you’ll have the opportunity to take ownership of moderately to highly complex workers' compensation claims and make a direct impact on outcomes for clients and claimants. You’ll drive investigations, evaluate coverage and liability, and shape claim strategies from start to resolution—balancing thoughtful analysis with decisive action. Your expertise will be key in setting reserves, negotiating fair settlements, and identifying risk and recovery opportunities. Along the way, you’ll build strong relationships with clients and stakeholders, ensure compliance with evolving regulations, and play a meaningful role in mentoring others and elevating team performance.

Essential Functions:

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

​ Education & Experience:

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,