Specialty Casualty Claims Adjuster- Construction Defect

At EMC, you'll put your skills to good use as an important member of our team. You can count on gaining valuable experience while contributing to the company's success.

EMC strives to hire and retain the best people by engaging, developing and rewarding employees.

This position is eligible to work from home in Central and Eastern Region states

Essential Functions :

• Reviews and evaluates the claim notice, contracts, state statutes and policies to verify the appropriate coverage, deductibles, and payees
• Investigates and evaluates complex coverage issues to determine applicable coverage, partnering with EMC Coverage Counsel and / or outside counsel as appropriate
• Initiates timely contact with insureds and claimants to explain the claim process and initiate the investigation
• Obtains statements from insureds, claimants, and witnesses and documents summaries within the claims system
• Requests and analyzes investigative and other relevant reports, claim forms and documents when appropriate
• Documents claim activities, reserve analysis, and summaries of reports including Medicare (MSP) modules in the claim system
• Sets and updates timely, adequate reserves in compliance with the company reserving philosophy and methodology
• Identifies, investigates, and proactively pursues opportunities for recovery including arranging of evidence preservation in legal compliance that meets custody, control, transfer, analysis, and disposition of physical and / or electronic evidence
• Adheres to all state requirements regarding regulatory compliance by sending out letters / forms containing appropriate language according to timelines
• Recommends and obtains authority from Supervisor / Director in the assignment of defense counsel
• Assigns and manages experts and third-party vendors for accuracy and appropriateness with supervisory approval as appropriate
• Reviews bills, receipts, legal invoices and litigation related expenses for accuracy and appropriateness
• Notifies the people leader of claims that may need escalation or reassignment
• Drafts reservation of rights and coverage denial letters with supervisor approval
• Assigns vehicle / property damage appraisals and vehicle rentals
• Provides prompt, detailed responses to agents, insureds and claimants on the status of claims
• Resolves questions of coverage, liability and the value of the claims and communicates with insureds and claimants to resolve claims in a timely manner
• Prepares bodily injury and / or damage evaluations, negotiation ranges and target settlement numbers prior to negotiation.

Obtains appropriate higher authority as required

• Identifies and protects all liens as appropriate
• Investigates Medicare liens and timely resolve in accordance with EMC and Medicare guidelines
• Communicates with insureds, claimants, and attorneys to negotiate the settlement of claims
• Attends and assists with suits, mediations, and arbitrations
• Prepares and issues settlement and release documents verifying accuracy and ensuring they are properly executed
• Issues timely payments
• Reviews and audits estimates written by independent adjusters, body shops, engineers, and other vendors for accuracy and to ensure the most cost-effective repair approach
• Submits referrals to the Estimatics, Special Investigation, Subrogation, Medical Review Units, and Claims Legal as appropriate
• Prepares risk reports for Underwriting and Risk Improvement
• Reviews coverage intent and policy activity with Underwriting
• Reviews account inspection information with Risk Improvement
• Prepares roundtable reports and participates in claims roundtables to discuss unique cases to evaluate coverage, liability, and damage
• Assists claims team members as appropriate in handling of claims
• Participates in projects as assigned
• Trains, and serves as a technical resource for team members
• Assists with account servicing and marketing as necessary
• Handles litigated claims files of moderate complexity
• Handles litigated claims files of moderate complexity
• Analyzes lawsuits by reviewing facts and allegations to determine coverage. Prepares Reservation of Rights and coverage denial letters if allegations warrant
• Prepares lawsuit analysis and formalizes plan to discuss with management
• Collaborates with defense counsel and others to prepare bodily injury and / or damage evaluations, negotiation ranges and target settlement numbers prior to negotiation.

Obtains higher authority when appropriate

• Negotiates claim settlements with plaintiff’s attorneys
• Completes litigation matters in the appropriate claims system
• Assigns files and collaborates with defense counsel on action plans and litigation strategy to manage litigation expenses and obtain favorable outcomes
• Secures all necessary official reports, claim forms and documents
• Reviews legal budget / invoices and litigation related expenses for accuracy and appropriateness
• Identifies, investigates, and proactively pursues opportunities for recovery
• Oversees suits, attends trials and mediations, and assists with mediations, depositions, and arbitrations

Education & Experience :

• Bachelor’s degree or equivalent relevant experience
• Five years of casualty claims adjusting experience or related experience, including at least one year of experience within assigned specialty line of business
• Relevant insurance designations preferred

Knowledge, Skills & Abilities :

• Strong knowledge of the theory and practice of the claim function
• Strong knowledge of insurance contracts, medical terminology and substantive and procedural laws
• Strong knowledge of computers and claims systems
• Ability to obtain all applicable state licenses
• Ability to adhere to high standards of professional conduct and code of ethics
• Good organizational and empathetic interpersonal skills
• Strong written and verbal communication skills
• Strong investigative and problem-solving abilities
• Excellent customer service skills
• Ability to maintain confidentiality
• Occasional travel required; a valid driver’s license with an acceptable motor vehicle report per company standards required if driving
12 days ago