Workers' Compensation Claims Adjuster I

EMC Insurance Companies

Claims Adjuster evaluating and resolving workers’ compensation claims within authority guidelines. Collaborating with insureds, agents, and internal teams while working remotely in the US.

Posted 5/14/2026full-timeRemote • 🇺🇸 United StatesJunior💰 $55,795 - $77,098 per yearWebsite

About the role

Key responsibilities & impact

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

Requirements

What you’ll need

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
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

Benefits

Comp & perks

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

ATS Keywords

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Applicant Tracking System Keywords

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Hard Skills & Tools

workers' compensation claims adjustingclaims investigationclaims evaluationnegotiationmedical treatment reviewbilling analysissubrogationsettlement documentationcompliance with jurisdictional requirementsclaims process explanation

Soft Skills

organizational skillswritten communicationverbal communicationproblem-solving abilitiesinvestigative skillsprofessional conductcollaborationnegotiation skillstime managementcustomer service

Certifications

state licensesinsurance designationsCEUs