Claims Assistant Manager (Workers' Compensation)

Claims Assistant Manager, Workers' Compensation

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.

Essential Functions

• Supervises assigned claims team and reviews claim files to ensure completeness, accuracy, and appropriate fact development.
• Assigns claims to handlers based on complexity, skills, and experience, and provides strategic guidance on coverage, compensability, liability, claim valuation, negotiation, and resolution.
• Reviews and approves reservation of rights and denial letters; assigns or assists with selection of defense counsel and monitors litigated matters.
• Ensures timely and appropriate reserving in compliance with client contracts, company guidelines, authority levels, and regulatory requirements.
• Ensures claims are handled in accordance with best practices, good‑faith standards, client special handling instructions, and claims philosophy, including proper file documentation.
• Oversees team workload, productivity, and performance; monitors dashboards, scorecards, and key performance metrics.
• Conducts file audits, identifies improvement opportunities, and implements action plans.
• Establishes performance goals, conducts performance reviews, provides coaching, and addresses disciplinary issues as needed.
• Interviews, hires, and manages compensation recommendations; develops team expertise and supports succession planning through talent identification and development plans.
• Supports diversity, equity, and inclusion initiatives and fosters a culture of innovation and continuous improvement.
• Builds and maintains strong relationships with clients, agents, brokers, and internal stakeholders through proactive communication and client visits.
• Organizes and leads client claim reviews and audits in collaboration with Client Services Management Consultants.
• Collaborates with ECS and EMC leadership to educate agents, promote compliance with carrier guidelines and excess reporting requirements, and recommend strategic process improvements.
• Promotes and markets the claims brand, culture, and value proposition internally and within the industry.
• Directly handles assigned claims in accordance with claims handling best practices and good‑faith standards.

Education & Experience

• Bachelor’s degree, preferably in insurance, or equivalent relevant experience
• Eight years of claims adjusting experience, including experience with large and complex claims
• Strong understanding of workers' compensation preferred
• Attainment of all applicable state licenses within six months of hire
• Prior leadership or supervisory experience preferred
• Prior experience with a third party administrator (TPA) preferred
• Insurance industry coursework (e.g. INS, AIC, CPCU) preferred

Knowledge, Skills, & Abilities

• Excellent understanding and application of claims techniques
• Advanced knowledge of insurance terms and coverages in commercial lines
• Excellent ability to gather and analyze a variety of data points to appropriately triage claims handling
• Advanced investigative and problem-solving abilities
• Analytical ability and good judgment regarding liability and coverage
• Strong leadership qualities with the ability to motivate staff and promote engagement
• Proven knowledge of insurance contracts, medical terminology and legal aspects of court procedures
• Excellent knowledge of computers and claims systems
• Superior organizational and written and verbal communication skills
• Occasional travel including overnight, valid driver’s license with an acceptable motor vehicle report per company standards will be required if driving

Key skills/competency

• Claims Management
• Workers' Compensation
• Team Leadership
• File Review
• Coverage Analysis
• Liability Assessment
• Negotiation
• Problem-Solving
• Client Relations
• Performance Management