Casualty Claims Adjuster I

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 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, and 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

Reviews bills, invoices and receipts for accuracy and appropriateness

Notifies 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

Makes recommendations to people leader on the assignment of independent adjusters

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 authority when required

 Identifies and protects all liens as appropriate

Investigates Medicare liens and resolves issues in accordance with EMC and Medicare guidelines

Communicates with insureds, claimants, and attorneys to negotiate the settlement of claims

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 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 teams as appropriate

Prepares risk reports for Underwriting and Risk Improvement

Prepares claims and participates in claims roundtables to discuss unique cases to evaluate coverage and damage
 

Education & Experience:
Bachelor’s degree or equivalent relevant experience

One year of casualty claims adjusting experience or related experience 

Relevant insurance designations preferred

Knowledge, Skills & Abilities:
Good knowledge of the theory and practice of the claim function

 Good 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

Good 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

The hiring salary range for this position will vary based on geographic location, falling within either of the following:
$55,795 - $77,098 or $61,659 - $84,778A 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.