Workers' Compensation Claims Adjuster I

🔥 12 hours ago

🇺🇸 United States – Remote

💵 $55.8k - $84.8k / year

⏰ Full Time

🟢 Junior

📋 Claims Specialist

👻 Ghost score 0%

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EMC Insurance Companies

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1001 - 5000 employees

Founded 1911

🛡️ Insurance

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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

• Review claim notices, policies, contracts, and applicable state requirements to determine coverage, jurisdiction, deductibles, and compensability • Conduct timely claim investigations by contacting insureds, injured workers, witnesses, and other relevant parties; obtaining statements; and securing reports and documentation • Document claim activity, maintain accurate file diaries, establish appropriate reserves, and ensure timely claim handling through resolution • Review medical records, treatment plans, bills, invoices, and other documentation to understand injuries, evaluate expenses, and coordinate appropriate medical care • Calculate and administer wage benefits while monitoring changes affecting benefit amounts • Coordinate return-to-work efforts with injured workers, insureds, medical providers, and other appropriate parties • Identify and pursue recovery and subrogation opportunities and refer claims to specialized resources • Investigate and resolve compensability and coverage issues and communicate decisions and claim status • Prepare settlement evaluations, negotiation strategies, IME documentation, and denial correspondence • Partner with attorneys and participate in mediations, settlement conferences, and other claim-resolution activities • Promote claims programs and resources, including OCN, RTW, and SPP programs • Collaborate with Claims, Underwriting, Risk Improvement, and other internal teams; prepare risk alerts and support broader claims initiatives

🎯 Requirements

• Bachelor’s degree or equivalent relevant experience • One year of workers’ compensation claims adjusting experience or related experience • Experience with Oklahoma, Kansas, Arkansas, and Kentucky preferred • 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

• Comprehensive rewards package • Remote work from home anywhere in the United States • Tobacco-free workplaces and company vehicles

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