Specialty Casualty Claims Adjuster- Environmental

EMC Insurance; United States; Remote; USD 77,000 - 118,000; Full time

Job summary

Join EMC Insurance as a Claims Adjuster, where you'll handle investigations and reviews of claim notices and contracts, ensuring compliance with regulatory requirements. With a supportive work environment and opportunities for remote work, this role offers a chance to make a positive impact while utilizing your skills in claims adjusting and customer service.

Qualifications

• At least five years of casualty claims adjusting or related experience.
• Relevant insurance designations preferred.
• Ability to obtain necessary state licenses.

Responsibilities

• Review and evaluate claim notices and contracts.
• Investigate and evaluate complex coverage issues.
• Manage experts and third-party vendors.

Skills

Strong knowledge of claims practices

Investigation skills

Problem-solving skills

Customer service skills

Communication skills

Education

Bachelor’s degree or equivalent experience

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

1. Review and evaluate claim notices, contracts, state statutes, and policies to verify appropriate coverage, deductibles, and payees.
2. Investigate and evaluate complex coverage issues, partnering with EMC Coverage Counsel and/or outside counsel as appropriate.
3. Initiate timely contact with insureds and claimants to explain the claim process and start investigations.
4. Obtain statements from insureds, claimants, and witnesses; document summaries within the claims system.
5. Request and analyze investigative reports, claim forms, and relevant documents.
6. Document claim activities, reserve analysis, and report summaries, including Medicare (MSP) modules in the claim system.
7. Set and update reserves in line with company reserving philosophy and methodology.
8. Draft roundtable and large loss reports.
9. Identify, investigate, and pursue recovery opportunities, including evidence preservation in legal compliance.
10. Ensure compliance with all state regulatory requirements by sending out appropriate letters/forms on time.
11. Obtain approval from Supervisor/Director for assigning defense counsel.
12. Manage experts and third-party vendors with supervisory approval, ensuring accuracy and appropriateness.
13. Review bills, receipts, legal invoices, and litigation expenses for accuracy.
14. Notify the people leader of claims needing escalation or reassignment.
15. Draft reservation of rights and coverage denial letters with supervisor approval.
16. Assign vehicle/property damage appraisals and vehicle rentals.
17. Provide prompt, detailed updates to agents, insureds, and claimants regarding claim status.
18. Resolve coverage, liability, and value questions; communicate with insureds and claimants to settle claims timely.
19. Prepare evaluations, negotiation ranges, and settlement targets; seek higher authority as needed.
20. Identify and protect liens appropriately.
21. Investigate Medicare liens and resolve in accordance with EMC and Medicare guidelines.
22. Negotiate settlements with attorneys and communicate with all parties involved.
23. Attend and assist with suits, mediations, and arbitrations.
24. Prepare and issue settlement and release documents, ensuring accuracy and proper execution.
25. Issue payments promptly.
26. Review estimates from vendors for accuracy and cost-effectiveness.
27. Refer cases to specialized units as appropriate.
28. Prepare risk reports for underwriting and risk improvement.
29. Review coverage and policy activity with underwriting and risk teams.
30. Participate in claims roundtables discussing coverage, liability, and damages.
31. Assist team members in handling claims and participate in projects.
32. Train and serve as a resource for team members.
33. Support account servicing and marketing as needed.
34. Handle litigated claims of moderate complexity, reviewing facts, and preparing necessary documentation.
35. Collaborate with defense counsel on case strategies and manage litigation expenses.
36. Secure official reports and documents, review legal invoices, and oversee legal expenses.
37. Identify recovery opportunities and oversee legal proceedings, including trials and mediations.

Education & Experience

• Bachelor’s degree or equivalent experience.
• At least five years of casualty claims adjusting or related experience, including one year in the specific line of business.
• Relevant insurance designations preferred.

Knowledge, Skills & Abilities

• Strong knowledge of claims practices, insurance contracts, medical terminology, and legal procedures.
• Proficiency with computers and claims systems.
• Ability to obtain necessary state licenses.
• High standards of professional conduct and ethics.
• Excellent organizational, interpersonal, and communication skills.
• Strong investigative, problem-solving, and customer service skills.
• Ability to maintain confidentiality.
• Occasional travel; valid driver’s license required if driving.

The salary range varies by location, typically between $77,013-$106,126 or $84,912-$117,001, depending on relevant experience, education, and geographic factors.

Our employment practices comply with applicable laws prohibiting discrimination based on race, color, creed, sex, sexual orientation, gender identity, genetic information, religion, age, national origin, disability, veteran status, military status, citizenship, marital status, or other protected categories.

All our locations are tobacco-free, including in company vehicles.