Senior Casualty Claims Adjuster

EMC Insurance; United States; Remote; USD 75,000 - 110,000; Full time

Benefits offered by this job

401(k) plan match

Tuition reimbursement

Life, medical, dental, vision coverage

Job summary

EMC Insurance is seeking an experienced claims adjuster to review notices, lawsuits, and policies to verify coverage and reserves. You will contact customers, take statements, and document outcomes in the claims system.

You will coordinate defense counsel for litigated claims, resolve coverage questions, and negotiate settlements with insureds and claimants while supporting branch teams and mentoring junior members. This remote role offers extensive benefits and professional growth.

Qualifications

• Bachelor’s degree or equivalent relevant experience.
• Five years of claims adjusting experience.
• Attainment of all applicable state licenses within six months of hire.
• Relevant insurance designations preferred.

Responsibilities

• Review claims to verify coverage, deductibles, and compensability.
• Initiate contact with customers to obtain information and explain the process.
• Take statements and document summaries in the claims system.
• Set reserves in line with company methodology.
• Coordinate defense counsel selection for litigated claims.
• Negotiate settlements with insureds and claimants.

Skills

Claims knowledge

Analytical thinking

Communication skills

Investigation skills

Medical terminology

Insurance contracts knowledge

Education

Bachelor’s degree or equivalent relevant experience

Five years of claims adjusting experience

Attainment of state licenses within six months

Relevant insurance designations preferred

Job description

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 notices, lawsuits, contracts and policies to verify coverage, deductibles, claim payee/mortgagees and compensability
• Initiates prompt contact with customers to obtain information on the claim and explain the claim process
• Takes statements from insureds/claimants/witnesses and documents summaries within the claims system
• Documents handling activity including Medicare (MSP) modules in the claims system
• Sets timely, adequate reserves in compliance with the company reserving philosophy and methodology
• Obtains authority in the selection of appropriate defense counsel for assignment based on the type of suit and complexity of the matter for litigated claims
• Handles medium to lower complexity lawsuits
• Resolves questions of coverage, liability and the value of claims
• Drafts reservation of rights and denial letters when appropriate
• Assigns independent adjusters when necessary with supervisory approval
• Secures all necessary official reports, claim forms and documents
• Reviews bills, invoices and receipts for accuracy
• Reviews legal invoices and litigation related expenses for accuracy and appropriateness
• Provides prompt, detailed responses to agents, insureds and claimants on the status of claims
• Identifies, investigates, and proactively pursues opportunities for recovery
• Prepares bodily injury and/or property damage evaluations, analyzes negotiation ranges and target settlement numbers prior to negotiation
• Communicates with insureds/claimants/attorneys to negotiate the settlement of claims
• Assists in suits, mediations, arbitrations and attending depositions
• Participates in Claims roundtables
• Issues settlement documents and verifies that they are properly executed
• Issues timely payments within check authority limit
• Investigates Medicare liens and timely resolve in accordance with EMC and Medicare guidelines
• Submits referrals to the Estimatics Review, Special Investigation, Property Review, Subrogation, Corporate Office Coverage Counsel, and Medical Review Units, when necessary
• Prepares risk reports for Underwriting
• Reviews coverage intent and policy activity with Underwriting Reviews account inspection information with Risk Improvement
• Assists own branch claims team members as needed.
• Acts as a mentor/coach for less experienced branch claims team members.
• Assists other branches in handling of claims (due to storms or temporary staffing gaps) through Resource Sharing Program.
• Participates in branch and department projects.

Education & Experience:

• Bachelor’s degree or equivalent relevant experience
• Five years of claims adjusting experience
• Attainment of all applicable state licenses within six months of hire
• Relevant insurance designations preferred

Knowledge, Skills & Abilities:

• Proven, excellent knowledge of the theory and practice of the claim function
• Analytical ability and sound judgment with respect to liability and coverage
• Strong knowledge of insurance contracts, medical terminology and legal aspects of court procedures
• High standards of professional conduct
• Strong knowledge of computers and claims systems
• Strong organizational and written and verbal communication skills
• Excellent investigative and problem-solving abilities

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 $74,059.31 - $95,108.00. The hiring range for other locations may vary. The hiring salary range for this position will vary based on geographic location, falling within either of the following: $72,726 - $99,800 or $79,834 - $109,786 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.

Why should you choose to apply for a position at EMC?

• More than 105 years of financial strength and stability
• Named a five-star insurance carrier by Insurance Business America
• Two-time recipient of the Best Practices Award of Excellence from the Independent Agents & Brokers of America
• Multiple locations recognized as Top Workplaces based solely on team member feedback
• Corporate culture that engages and empowers team members to achieve their best
• Outstanding benefits with life, medical, dental, vision and prescription drug coverage
• Competitive paid time off plan and a full day of volunteer time off annually
• Financial incentives, including a 401(k) plan match, pension plan, OneEMC bonus plan and recognition and anniversary awards
• Professional development and growth opportunities, including tuition reimbursement
• Wellness initiatives to improve team member well-being and reduce health insurance costs
• Flexibility to dress for your day and opportunities for alternative work arrangements

EMC complies with labor law requirements.

View the federal and e-verify labor law posters.

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