Senior Claims Adjuster – WC

🔥 15 hours ago

🐊 Florida, North Carolina, +1 more states – Remote

🐊 Florida – Remote 🌲 North Carolina – Remote 🌴 South Carolina – Remote

💵 $78.7k - $119.6k / year

⏰ Full Time

🟠 Senior

📋 Claims Specialist

👻 Ghost score 0%

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EMC Insurance Companies

WebsiteLinkedInAll Job Openings

1001 - 5000 employees

Founded 1911

🛡️ Insurance

Insurance

EMC Insurance Companies is a mutual insurance firm providing specialized business insurance solutions. They focus on commercial property insurance, liability insurance, workers' compensation, and business owners' policies. With a strong emphasis on personalized service, EMC collaborates closely with local agents to deliver comprehensive and tailored coverage. EMC is committed to understanding the unique challenges faced by its policyholders, offering risk management and loss control resources to help businesses safeguard their assets. Known for their dedicated partnerships and exceptional customer service, EMC ensures that businesses are prepared for the unexpected with their superior insurance solutions.

📋 Description

• Take ownership of moderately to highly complex workers’ compensation claims from investigation through resolution • Analyze coverage, liability, compensability, treatment, claim value, and policy applicability • Initiate contact with clients, claimants, employees, and medical providers within 24 hours • Conduct fact-finding, investigations, and recorded statements • Develop and execute action plans to resolve claims efficiently • Perform reserve analysis and set or maintain appropriate reserves • Review medical records and bills • Identify and pursue risk, recovery, and subrogation opportunities • Route claims for specialized handling, including SIU, subrogation, and medical review • Escalate complex claims and collaborate with leadership • Prepare jurisdictional filings, denial documentation, settlement documentation, and claim evaluations • Negotiate settlements, participate in mediation, and manage payments within authority limits • Support litigation, mediation, arbitration, and Medicare compliance • Maintain diaries and action plans, provide claim updates, conduct client consultations, coordinate vendors, and manage reporting • Stay current on regulations and maintain licenses and CEUs • Mentor and support training of team members

🎯 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 and CPCU coursework or designation preferred • Workers' compensation claims adjusting experience in FL, GA, NC, or SC preferred • Excellent knowledge of the theory and practice of the claim function • Excellent analytical, investigative, and problem-solving abilities regarding liability and coverage • Thorough knowledge of insurance contracts, medical terminology, and legal aspects of court procedures affecting legal liability • Strong computer skills, including claims systems • Strong organizational, written, and verbal communication skills, including documentation • Strong ability to advise, partner, and consult with diverse internal and external stakeholders • Valid driver’s license with an acceptable motor vehicle report per company standards

🏖️ Benefits

• Comprehensive rewards package; benefits details provided at www.emcins.com/careers • Work from home • Occasional travel required • Tobacco-free workplaces and company vehicles