Senior Claims Adjuster, Workers' Compensation

🔥 13 hours ago

🏄 California – Remote

🏄 California – 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 start to resolution • Analyze coverage to confirm losses are covered under client policies • Initiate contact within 24 hours with relevant parties • Conduct fact-finding, recorded statements, and thorough claim investigations • Develop and execute action plans to resolve claims efficiently • Perform reserve analysis and set or maintain appropriate reserves • Review medical records and bills to assess injury, compensability, treatment, and accuracy • Identify risk factors and route claims for specialized handling • Investigate and pursue subrogation opportunities • Escalate complex claims and collaborate with leadership • Prepare required jurisdictional filings • Evaluate coverage, liability, and claim value • Negotiate settlements, participate in mediation, and manage payments within authority limits • Prepare denial and settlement documentation and support litigation, mediation, arbitration, and Medicare compliance • Maintain diaries and action plans, provide claim updates, conduct client consultations, coordinate vendor resources, and manage reporting • Stay current on regulations, maintain licenses/CEUs, support team training, mentor others, and elevate team performance

🎯 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 California 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 for all lines of insurance • 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 • Occasional travel required • Valid driver’s license with an acceptable motor vehicle report per company standards • Ability to maintain licenses/CEUs

🏖️ Benefits

• Comprehensive rewards package • Remote work from home anywhere in the state of California • Occasional travel • Tobacco-free workplaces and company vehicles