Casualty Claims Adjuster I

EMC Insurance Companies

1d•$55,795 - $84,778•Remote

About The Position

This position is eligible to work from home anywhere in the US. As a Casualty Claims Adjuster, you'll independently investigate, evaluate, negotiate, and resolve moderate-complexity claims while delivering exceptional service to insureds, claimants, agents, and business partners. Your expertise in coverage analysis, liability evaluation, settlement negotiations, and regulatory compliance will help drive fair, timely claim resolutions and positive customer outcomes. Working closely with cross-functional claims and underwriting teams, you'll play a key role in protecting the company, supporting policyholders, and ensuring claims are handled efficiently from first notice through final resolution.

Requirements

Bachelor’s degree or equivalent relevant experience
One year of casualty claims adjusting experience or related experience
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

Nice To Haves

Relevant insurance designations preferred

Responsibilities

Investigate and evaluate low to moderate complexity auto and casualty claims, ensuring coverage, deductibles, and payees are verified.
Initiate timely contact with insureds, claimants, and witnesses; obtain and document statements and relevant claim information.
Gather, review, and analyze investigative reports, claim forms, contracts, policies, and supporting documentation.
Maintain accurate claim documentation, reserve analyses, and Medicare reporting within the claims system.
Establish and manage adequate reserves in accordance with company reserving guidelines.
Identify recovery opportunities, pursue subrogation, preserve evidence, and ensure regulatory compliance, including required correspondence and claim forms.
Review bills, invoices, receipts, appraisals, and repair estimates for accuracy, appropriateness, and cost effectiveness.
Draft coverage-related correspondence, recommend claim escalation or reassignment when needed, and provide responsive claim status updates to agents, insureds, and claimants.
Evaluate coverage, liability, damages, and claim value; prepare settlement strategies, obtain authority, and negotiate timely claim resolutions.
Manage liens, including Medicare-related issues, and prepare settlement, release, and payment documentation.
Collaborate with internal teams, including Estimatics, SIU, Subrogation, Medical Review, and Claims Legal, by submitting referrals and sharing claim insights.
Prepare risk reports and participate in claim roundtables to evaluate complex cases, coverage issues, and damages.