Senior Claims Adjuster (Workers' Compensation)
About The Position
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.
Requirements
- Bachelor’s degree or equivalent relevant experience
- Five years of claims adjusting experience or related experience
- 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 effectively consult with diverse internal and external stakeholders
- Occasional travel required; a valid driver’s license with an acceptable motor vehicle report per company standards
Nice To Haves
- Prior experience with a third party administrator (TPA) preferred
- INS, AIC, SCLA, WCLA and CPCU coursework or designation preferred
- Workers' compensation claims adjusting experience within the following jurisdictions preferred: IA, IL, WI, KS
Responsibilities
- Analyzes coverage to confirm losses are covered under client policies
- Initiates contact within 24 hours with all relevant parties (clients, claimants, employees, medical providers)
- Conducts thorough investigations, including fact-finding and recorded statements
- Develops and executes action plans to resolve claims efficiently
- Performs reserve analysis and sets/maintains appropriate reserves per client guidelines
- Reviews medical records and bills to assess injury, compensability, treatment, and accuracy
- Identifies risk factors and routes claims for specialized handling (SIU, subrogation, medical review) with approval
- Identifies, investigates, and pursues subrogation opportunities, including review of official reports
- Escalates complex claims and collaborates with leadership as needed
- Prepares required jurisdictional filings for workers’ compensation claims
- Evaluates coverage, liability, and claim value; responds to stakeholder inquiries
- Negotiates settlements, participates in mediation, and manages payments within authority limits; recommends higher-value settlements
- Prepares and issues denial and settlement documentation; develops evaluation ranges and supports litigation, mediation, arbitration, and Medicare compliance
- 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
Benefits
- life, medical, dental, vision and prescription drug coverage
- Competitive paid time off plan
- a full day of volunteer time off annually
- 401(k) plan match
- pension plan
- OneEMC bonus plan
- recognition and anniversary awards
- Professional development and growth opportunities
- tuition reimbursement
- Wellness initiatives to improve team member well-being and reduce health insurance costs
- Flexibility to dress for your day
- opportunities for alternative work arrangements
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What This Job Offers
Job Type
Full-time
Career Level
Senior
