Casualty Claims Adjuster II

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 anywhere in the United States

Essential Functions :

Promptly investigates and evaluates moderately complex auto and casualty claims

Reviews the claim notice, contracts, state statutes and policies to verify the appropriate coverage, deductibles, and payees

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

Request and analyze investigative and other relevant reports, claim forms and documents when appropriate

Documents claim activities, reserve analysis, summaries of reports including Medicare (MSP) modules in the claim system

Sets 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

Handles litigated files of low complexity

Recommends and obtains authority from appropriate people leader in the assignment of defense counsel

Assigns and manages 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

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 claims 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

Education & Experience :

Bachelor’s degree or equivalent relevant experience

Three years of casualty claims adjusting experience or related experience

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 traveling

Per the Colorado Equal Pay for Equal Work Act, the hiring range for this position for Colorado-based team members is $62,344.

10 - $80,035.80. The hiring range for other locations may vary.