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Senior Claims Adjuster (Workers' Compensation)

June 3, 2026

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:<div><div><ul><li>Analyzes coverage to confirm losses are covered under client policies</li><li>Initiates contact within 24 hours with all relevant parties (clients, claimants, employees, medical providers)</li><li>Conducts thorough investigations, including fact-finding and recorded statements</li><li>Develops and executes action plans to resolve claims efficiently</li><li>Performs reserve analysis and sets/maintains appropriate reserves per client guidelines</li><li>Reviews medical records and bills to assess injury, compensability, treatment, and accuracy</li><li>Identifies risk factors and routes claims for specialized handling (SIU, subrogation, medical review) with approval</li><li>Identifies, investigates, and pursues subrogation opportunities, including review of official reports</li><li>Escalates complex claims and collaborates with leadership as needed</li><li>Prepares required jurisdictional filings for workers’ compensation claims</li><li>Evaluates coverage, liability, and claim value; responds to stakeholder inquiries</li><li>Negotiates settlements, participates in mediation, and manages payments within authority limits; recommends higher-value settlements</li><li>Prepares and issues denial and settlement documentation; develops evaluation ranges and supports litigation, mediation, arbitration, and Medicare compliance</li><li>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</li></ul></div></div>Education & Experience:<ul><li>Bachelor’s degree or equivalent relevant experience</li><li>Five years of claims adjusting experience or related experience</li><li>Prior experience with a third party administrator (TPA) preferred</li><li>INS, AIC, SCLA, WCLA and CPCU coursework or designation preferred</li><li>Workers' compensation claims adjusting experience within the following jurisdictions preferred: IA, IL, WI, KS</li></ul>Knowledge, Skills, & Abilities: <ul><li>Excellent knowledge of the theory and practice of the claim function</li><li>Excellent analytical, investigative and problem-solving abilities with respect to liability and coverage</li><li>Thorough knowledge of insurance contracts, medical terminology and legal aspects of court procedures affecting legal liability for all lines of insurance. </li><li>Strong computer skills, including claims systems</li><li>Strong organizational, written, and verbal communication skills, including documentation</li><li>Strong ability to advise, partner, and effectively consult with diverse internal and external stakeholders</li><li>Occasional travel required; a valid driver’s license with an acceptable motor vehicle report per company standards</li></ul>The hiring salary range for this position will vary based on geographic location, falling within either of the following:$78,726 - $108,771 or $87,008 - $119,646A 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 <a href="https://www.emcinsurance.com/careers" target="_blank" rel="noopener noreferrer">www.emcins.com/careers</a>.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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Common Interview Questions And Answers

1. HOW DO YOU PLAN YOUR DAY?

This is what this question poses: When do you focus and start working seriously? What are the hours you work optimally? Are you a night owl? A morning bird? Remote teams can be made up of people working on different shifts and around the world, so you won't necessarily be stuck in the 9-5 schedule if it's not for you...

2. HOW DO YOU USE THE DIFFERENT COMMUNICATION TOOLS IN DIFFERENT SITUATIONS?

When you're working on a remote team, there's no way to chat in the hallway between meetings or catch up on the latest project during an office carpool. Therefore, virtual communication will be absolutely essential to get your work done...

3. WHAT IS "WORKING REMOTE" REALLY FOR YOU?

Many people want to work remotely because of the flexibility it allows. You can work anywhere and at any time of the day...

4. WHAT DO YOU NEED IN YOUR PHYSICAL WORKSPACE TO SUCCEED IN YOUR WORK?

With this question, companies are looking to see what equipment they may need to provide you with and to verify how aware you are of what remote working could mean for you physically and logistically...

5. HOW DO YOU PROCESS INFORMATION?

Several years ago, I was working in a team to plan a big event. My supervisor made us all work as a team before the big day. One of our activities has been to find out how each of us processes information...

6. HOW DO YOU MANAGE THE CALENDAR AND THE PROGRAM? WHICH APPLICATIONS / SYSTEM DO YOU USE?

Or you may receive even more specific questions, such as: What's on your calendar? Do you plan blocks of time to do certain types of work? Do you have an open calendar that everyone can see?...

7. HOW DO YOU ORGANIZE FILES, LINKS, AND TABS ON YOUR COMPUTER?

Just like your schedule, how you track files and other information is very important. After all, everything is digital!...

8. HOW TO PRIORITIZE WORK?

The day I watched Marie Forleo's film separating the important from the urgent, my life changed. Not all remote jobs start fast, but most of them are...

9. HOW DO YOU PREPARE FOR A MEETING AND PREPARE A MEETING? WHAT DO YOU SEE HAPPENING DURING THE MEETING?

Just as communication is essential when working remotely, so is organization. Because you won't have those opportunities in the elevator or a casual conversation in the lunchroom, you should take advantage of the little time you have in a video or phone conference...

10. HOW DO YOU USE TECHNOLOGY ON A DAILY BASIS, IN YOUR WORK AND FOR YOUR PLEASURE?

This is a great question because it shows your comfort level with technology, which is very important for a remote worker because you will be working with technology over time...