Casualty Claims Specialist

EMC Insurance Companies

2d•$78,726 - $119,646•Remote

About The Position

This position is eligible to work from home anywhere in the US. The Casualty Claims Specialist exercises independent judgment in the investigation, negotiation, and disposition of auto and casualty claims of severe complexity, including claims in litigation, within limitations of authority outlined in the Claims Guide. Maintains and reinforces department procedures. Communicates effectively with insureds, claimants, vendors, and agents, regarding coverage, claims status and other claims questions.

Requirements

Bachelor’s degree or equivalent relevant experience
Eight years of casualty claims adjusting experience or related experience
Ability to obtain all applicable state licenses
Occasional travel required; a valid driver’s license with an acceptable motor vehicle report per company standards required if driving

Nice To Haves

Relevant insurance designations preferred

Responsibilities

Promptly investigates and evaluates claims of severe complexity: Reviews the claim notice, contracts, state statutes and policies to verify the appropriate coverage, deductibles, and payees. Investigates and evaluates complex coverage issues to determine applicable coverage, partnering with EMC Coverage Counsel and/or outside counsel as appropriate. 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. Requests and analyzes investigative and other relevant reports, claim forms and documents when appropriate. Documents claim activities, reserve analysis, summaries of reports including Medicare (MSP) modules in the claim system. Prepares claims and participates in claims roundtables to discuss unique cases to evaluate coverage, liability, and damages. Sets timely, adequate reserves in compliance with the company reserving philosophy and methodology. Identifies, investigates, and proactively pursues opportunities for recovery including partnering with attorneys and/or other experts to arrange 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. Recommends and obtains authority from Supervisor/Director in the assignment of defense counsel. Notifies people leader of claims that may need escalation or reassignment. Assign and manage experts and third party vendors for accuracy and appropriateness with supervisory approval as required. Drafts reservation of rights and denial letters when appropriate. Provides prompt, detailed responses to agents, insureds and claimants on the status of claims.
Manages litigation of moderate to complex claims: Analyzes lawsuits by reviewing facts and allegations to determine coverage. Prepares any Reservation of Rights letters if allegations warrant. Prepares lawsuit analysis and formalizes plan to discuss with management. Collaborates with defense counsel and others to prepare bodily injury and/or damage evaluations, negotiation ranges and target settlement numbers prior to negotiation. Obtains higher authority when appropriate. Negotiates claim settlements with plaintiff’s attorneys. Completes litigation matters in CLMS claims system. Assigns files and collaborates with defense counsel on action plans and litigation strategy to manage litigation expenses and obtain favorable outcomes. Secures all necessary official reports, claim forms and documents. Reviews legal budget/invoices and litigation related expenses for accuracy and appropriateness. Identifies, investigates, and proactively pursues opportunities for recovery. Oversees suits, attends and assists with mediations, arbitrations, and depositions.
Negotiates, settles and/or resolves 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 higher authority when appropriate. Identifies and protects all liens as appropriate. Investigates Medicare liens and timely resolve 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. Reviews and audits estimates written by independent adjusters, engineers and other vendors for accuracy and to ensure the most cost-effective repair approach. Issues timely payments.
Serves as a technical resource for team members: Provides guidance to team members with technical issues of a claim and answers questions on coverage, compensability, investigations and plans of action. Serves as a subject matter expert for other claims team members. Assists in handling of claims or suits outside of their jurisdiction. Acts as a technical resource to other claims professionals providing guidance on claims handling practice. Assists other claims professionals with complex or problematic claims as necessary. Leads and/or participates in claims projects as a representative of casualty claims.
Collaboration: Submits referrals to the Estimatics, Special Investigation, Subrogation, Medical Review Units, and Corporate Office Coverage Counsel as appropriate. Prepares risk reports for Underwriting and Risk Improvement. Reviews coverage intent and policy activity with Underwriting. Reviews account inspection information with Risk Improvement. Prepares claims and participates in claims roundtables to discuss unique cases to evaluate coverage and damage.