Complex Casualty Claims Consultant

EMC Insurance Companies

3d•$112,276 - $177,469•Remote

About The Position

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 Collaborates with casualty claims team members with the review of claims and on resolution strategies for complex casualty claims. Serves as a subject matter expert on casualty claims policies and insurance programs. Collaborates with casualty claims leadership on claim file strategy including reserving, expense and litigation management. Serves as the point person to monitor progress on casualty claims wide audit action plan items implemented by the Casualty Claims leadership. Monitors and evaluates reserve development for assigned teams. Serves as a technical resource for all levels of Claim department for casualty claims.

Requirements

Bachelor’s degree or equivalent relevant experience
Ten years of casualty claims experience in progressively responsible roles or related experience, including complex claims experience
Attainment of all applicable state licenses as required
Superior knowledge of the theory and practice of the casualty claims function
Strong analytical abilities and demonstrated experience of good judgment with respect to casualty loss and coverage
Proven knowledge of insurance contracts, medical terminology and legal aspects of court procedures affecting legal liability for all lines of insurance
Strong, current knowledge of all insurance lines, relevant court decisions, guidelines in the claims function, and policy changes and modifications
Excellent leadership qualities with the ability to motivate branch claims team members in the handling and disposition of claims
Excellent knowledge of computers and claims systems
Superior organizational and written and verbal communication skills
Excellent investigative and problem-solving abilities
Occasional travel; a valid driver’s license with an acceptable motor vehicle report per company standards required if driving

Nice To Haves

Insurance designations, such as AIC, CIC, AIM and CPCU preferred

Responsibilities

Collaborates with complex casualty claims team members with the review of claims and on resolution strategies
Serves as a subject matter expert on complex casualty claims policies and insurance programs
Represents the Complex Casualty Claims department when addressing escalated complex casualty claims concerns or issues. Works closely with other appropriate teams, including Claims Legal, Coverage Counsel, Underwriting, and external vendors, to resolve casualty claims handling, coverage and/or contractual issues
Works collaboratively with complex casualty claims team members and other departments to identify and resolve issues and gain alignment on claim strategies
Collaborates with complex casualty claims leadership on claim file strategy including reserving, expense and litigation management
Provides technical expertise and input on reserve recommendations to the Complex Casualty Claims Director
Prepares for and routinely participates in roundtables. Prepares conference reports on individual claims for discussion and provides proper notice of cases discussed and ensures action is taken by file handler
Maintains a caseload of major files to consult on and monitor progress
Provides reserve and settlement authority for cases within their authority
Provides ongoing support for claims, including the oversight and implementation of best practices for Claims Directors, Claims Supervisors, and adjusters
Actively participates in claim committee and takes on a coaching role for other presenters
Collaborates with the Claims Compliance and Quality Assurance team and Complex Casualty Claims Director to provide ongoing support for casualty claim handling, including oversight and implementation of best practices for the casualty team members
Serves as the point person to monitor progress on complex casualty claims audit action plan items implemented by the Complex Casualty Claims leadership and works closely with these parties to report to the Complex Casualty Claims Director
Leverages Voice of the Customer insights on all aspects of customer interactions to identify customer pain points, challenges, and hurdles. Advises and collaborates with Complex Casualty Claims leadership on approaches to positively enhance customer interactions and reduce undesirable experiences
Serves as the subject matter expert from the complex casualty claims department on the business continuity committee to ensure the complex casualty claims department is able to adapt and operate efficiently during a disaster or claims system interruption
Monitors and evaluates reserve development for assigned teams
Serves as a technical resource for all levels of Claim department for complex casualty claims
Evaluates department staffing needs to effectively provide superior customer service
Serves on hiring panels for complex casualty claims openings
Collaborates with other Claim leaders in the process of identifying, interviewing and selecting outside counsel and independent adjuster firms
Leads or participates in claims and enterprise projects
Coordinates resources and team members for implementation of policies and procedures for the casualty claims department
Follows up on projects after implementation to ensure success
As part of the complex casualty claims leadership team, participates in establishing and maintaining of claims service standards and procedures for the investigation, evaluation, and disposition of claims.
Participates in Claim Committee and other committees
Reports timely and thoroughly to reinsurance carriers on reinsured losses.
Conducts claim file and panel counsel evaluations
Collaborates with all facets of claim leaders including claim consultants
Reviews claim files to ensure compliance with EMC claim handling guidelines and best practices
Evaluates claim file handling to ensure that processes and procedures are in compliance with EMC claims guides and manuals and communicates evaluation findings to leaders
Assists Claims operation with action planning to audits and follow-up/through to ensure improvements are made and sustained
Participates in the establishment of claims service standards and procedures for the investigation, evaluation, and disposition of claims.