Senior Casualty Claims Adjuster

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:

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.**

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.

R5374

Remote/Remotely/Tele/Telecommute/From home