Workers' Compensation Claims Adjuster I

Role Overview

• Independently investigates, evaluates, negotiates, and resolves workers’ compensation claims within authority guidelines; communicates with insureds, agents, and partners on coverage, status, and inquiries
• Investigates and evaluates claims, verifying coverage, jurisdiction, and compensability
• Initiates timely contact with insureds, claimants, and relevant parties to explain the claims process
• Gathers statements, documentation, and official reports; documents all file activity and updates claim records
• Sets and adjusts reserves in line with company guidelines
• Reviews medical treatment, billing, and wage data to determine appropriate benefits and payments
• Coordinates medical care and return-to-work efforts
• Identifies and pursues subrogation and recovery opportunities
• Ensures timely statutory notifications and compliance with jurisdictional requirements
• Monitors claim progress and escalates complex claims as needed
• Prepares settlement evaluations, strategies, and negotiation targets
• Investigates and resolves compensability and coverage issues
• Negotiates settlements and collaborates with attorneys; attends mediations and conferences as needed
• Issues settlement documentation and payments within authority limits
• Provides clear, timely claim status updates to insureds, agents, and claimants
• Ensures compliance with all state reporting and documentation requirements
• Collaborates with internal teams (SIU, Subrogation, Medical, etc.) and supports team members
• Submits referrals and promotes programs such as return-to-work and preferred provider networks
• Assists with account servicing and marketing efforts as needed
• Maintains licenses/CEUs and completes ongoing training on regulatory and medical updates

Requirements

• Bachelor’s degree or equivalent relevant experience
• One year of workers’ compensation claims adjusting experience or related experience
• 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

• Outstanding benefits with life, medical, dental, vision and prescription drug coverage
• Competitive paid time off plan and a full day of volunteer time off annually
• Financial incentives, including a 401(k) plan match, pension plan, OneEMC bonus plan and recognition and anniversary awards
• Professional development and growth opportunities, including tuition reimbursement
• Wellness initiatives to improve team member well-being and reduce health insurance costs
• Flexibility to dress for your day and opportunities for alternative work arrangements