Claims Specialist

EMC Insurance Companies

11d•$85,799 - $130,394

About The Position

EMC is seeking a Claims Specialist to investigate and manage complex, multi-line and multi-state claims, including general liability and workers’ compensation losses. The position evaluates coverage, liability, compensability, damages, and settlement exposure; develops claim resolution strategies; establishes reserves; negotiates and resolves claims within assigned authority; and ensures accurate documentation and compliance with applicable requirements. The Claims Specialist works with clients, defense counsel, and internal specialized resources to resolve claims and provide guidance on litigation and claim strategies. The role also builds client relationships, analyzes claim and settlement trends, and serves as a technical resource to other Claims team members. Coverage includes Iowa, Arizona, Utah, and Texas, and occasional travel is required.

Requirements

Bachelor’s degree or equivalent relevant experience.
Seven years of claims adjusting experience or related experience.
Adjuster experience in Iowa, Arizona, and Utah.
Advanced knowledge of best claims practices used to resolve serious and complex injury, workers’ compensation, general liability, property, and commercial auto claims.
Excellent knowledge of the claim function.
Advanced analytical, investigative, and problem-solving abilities with liability and coverage.
Excellent knowledge of insurance contracts, medical terminology, and legal aspects of court procedures affecting legal liability for all lines of insurance.
Advanced computer skills, including claims systems.
Exceptional organizational, written, and verbal communication skills, including documentation.
Thorough investigative and problem-solving abilities.
Excellent ability to advise, partner, and effectively consult with diverse internal and external stakeholders.
Occasional travel required.

Nice To Haves

Adjuster experience in Texas.
Prior experience with a third-party administrator (TPA).
INS, AIC, SCLA, WCLA, or CPCU designation.

Responsibilities

Investigate and manage complex, multi-line and multi-state claims, including general liability and workers’ compensation losses.
Review coverage, investigate facts of loss, obtain statements, evaluate medical and loss information, and develop effective claim resolution strategies.
Establish appropriate reserves and maintain accurate, timely claim documentation in accordance with client handling requirements.
Evaluate coverage, liability, compensability, damages, and settlement exposure, and communicate claim decisions to appropriate parties.
Identify and pursue subrogation opportunities and coordinate referrals to specialized resources, including Special Investigation and Medical Review.
Negotiate and resolve complex claims within assigned authority, including preparing claim evaluations, settlement ranges, denial correspondence, and settlement documentation.
Partner with defense counsel on litigated claims and provide clients with guidance regarding litigation and resolution strategies.
Maintain compliance with applicable state reporting, Medicare, excess carrier, and other claim-related requirements.
Build client relationships through responsive communication, consultation, file reviews, claim summaries, and coordination of appropriate resources.
Analyze claim and settlement trends to identify opportunities and support client needs.
Maintain required professional licenses and continuing education, and stay current on jurisdictional and industry developments.
Serve as a technical resource to Claims team members, providing guidance on coverage, compensability, investigations, and claim strategy.