Workers-Compensation-Claims-Adjuster, Claims-Adjuster, Insurance-Claims-Specialist Jobs

At EMC, we’re all about working together to make an impact. As part of our team, you’ll have the opportunity to grow, contribute, and gain experience that matters. We strive to be caring leaders, close partners, and responsive experts—always supporting each other to do our best work. Join us, and let’s improve lives together.

**This position is eligible to work from home anywhere in the United States**

Essential Functions

• Reviews claim notices, policies, contracts, and applicable state requirements to determine coverage, jurisdiction, deductibles, and compensability.
• Conducts timely claim investigations, including contacting insureds, injured workers, witnesses, and other relevant parties; obtaining statements; and securing necessary reports and documentation.
• Documents claim activity, maintains accurate file diaries, establishes appropriate reserves, and ensures timely claim handling through resolution.
• Reviews medical records, treatment plans, bills, invoices, and other documentation to understand injuries, evaluate expenses, and coordinate appropriate medical care.
• Calculates and administers wage benefits while monitoring changes that may affect benefit amounts.
• Coordinates return-to-work efforts with injured workers, insureds, medical providers, and other appropriate parties.
• Identifies and pursues recovery and subrogation opportunities and refers claims to specialized resources, including Special Investigation and medical management or review teams, when appropriate.
• Investigates and resolves compensability and coverage issues and communicates decisions and claim status to relevant parties.
• Prepares settlement evaluations, negotiation strategies, independent medical examination (IME) documentation, and denial correspondence as appropriate.
• Partners with attorneys and participates in mediations, settlement conferences, and other activities to facilitate claim resolution.
• Promotes appropriate claims programs and resources, including On Call Nurse (OCN), Return to Work (RTW), and Select Preferred Provider (SPP) programs.
• Collaborates with Claims, Underwriting, Risk Improvement, and other internal teams, including preparing risk alerts and supporting broader claims initiatives as needed.

Education & Experience:

• 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

Knowledge, Skills & Abilities:

• 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

The hiring salary range for this position will vary based on geographic location, falling within either the $54,566-$75,194 range or the $60,168-$82,916 range. A hiring range represents a subset of the full salary range. The actual salary will depend on several factors, including relevant education, skills, and experience of an applicant, geographic location, and business needs.

The hiring salary range for this position will vary based on geographic location, falling within either of the following:

A hiring range represents a subset of the full salary range. The actual salary will depend on several factors, including relevant education, skills, and experience of an applicant, geographic location, and business needs.

For information relating to the benefits EMC Team Members receive as part of a comprehensive rewards package, please visit www.emcins.com/careers.

Our employment practices are in accordance with the laws that prohibit discrimination due to race, color, creed, sex, sexual orientation, gender identity, genetic information, religion, age, national origin or ancestry, physical or mental disability, medical condition, veteran status, active military status, citizenship status, marital status or any other consideration made unlawful by federal, state, or local laws.

All of our locations are tobacco free including in company vehicles.

Originally posted on Himalayas

Workers Compensation Claims Adjuster (Northeast Jurisdictions)

Location: Work from Home

Who says you can't have it all? Cottingham & Butler Claims Services (CBCS) is offering the opportunity to work in a fast-paced and exciting position with NO commute! You will be working from home so previous workers compensation adjusting experience is required (i.e. taking statements, paying lost wage benefits, filing state forms, denying claims, subrogation, litigation, etc.).

As a Work Comp Adjuster, you will be responsible for investigating, evaluating, negotiating, and settling workers compensation claims on behalf of our clients. The ideal candidate will have excellent communication and negotiation skills, be detail-oriented, and possess a strong understanding of workers compensation laws and regulations. You will be communicating with a wide variety of individuals, to include CEO's, claimants, providers offices, and attorneys. Experience handling claims in multiple jurisdictions is vital for success in this role.

Qualifications:

• Minimum of 1 year experience as a workers compensation claims adjuster.
• License/state experience in the Northeast states.
• Demonstrated knowledge of workers compensation laws and regulations.
• Strong analytical and problem-solving skills.
• Excellent communication and negotiation skills.
• Ability to work independently and in a team environment.
• Strong organizational and time-management skills.
• Proficiency in computer programs, including Microsoft Office and claims management software.

If you are looking for a position that will allow you to stay in claims, continue to grow in your career, and also have the flexibility that working from home allows, this is the position for you. We will provide your office equipment and IT support, as well as training and support from our home office.

If this sounds like a good fit to your career and life goals, we'd love to talk!

Pay & Benefits

• Salary – Flexible based on your experience level.
• Most Benefits start Day 1
• Medical, Dental, Vision Insurance
• Flex Spending or HSA
• 401(k) with company match
• Profit-Sharing/ Defined Contribution (1-year waiting period)
• PTO/ Paid Holidays
• Company-paid ST and LT Disability
• Maternity Leave/ Parental Leave
• Company-paid Term Life/ Accidental Death Insurance

Cottingham & Butler

At Cottingham & Butler, we sell a promise to help our clients through life’s toughest moments. To deliver on that promise, we aim to hire, train, and grow the best professionals in the industry. We look for people with an insatiable desire to succeed, are committed to growing, and thrive on challenges. Our culture is guided by the theme of “better every day” constantly pushing ourselves to be better than yesterday – that’s who we are and what we believe in.

As an organization, we are tremendously optimistic about the future and have incredibly high expectations for our people and our performance. Our ability to grow as a company, fuels investments in new resources to better serve our clients and provide the amazing career opportunities our employees want and deserve. This is why we are a growth company and why we are committed to being better every day.

Want to learn more? Follow us on www.CBCSclaims.com | LinkedIn

Originally posted on Himalayas