Complex Casualty Claims Specialist

EMC Insurance Companies

4d•$100,085 - $152,122•Remote

About The Position

This position is eligible to work from home anywhere in the United States. Manages litigation of severely complex claims. Promptly investigates and evaluates severely complex auto and casualty claims identified as complex per EMC’s claims handling guidelines. Sets and updates timely, adequate reserves in compliance with the company reserving philosophy and methodology. Negotiates, settles and/or resolves severely complex claims.

Requirements

Bachelor’s degree or equivalent relevant experience
Ten years of casualty claims adjusting experience or related experience
Ability to obtain all applicable state licenses
Ability to adhere to high standards of professional conduct and code of ethics
Thorough written and verbal communication skills
Advanced customer service skills
Ability to maintain confidentiality
Thorough investigative and problem-solving abilities.
Frequent travel required nationwide; 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

Manages litigation of severely complex claims
Analyzes lawsuits by reviewing facts and allegations to determine coverage. Prepares any Reservation of Rights letters and coverage position letters if warranted
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 and Claims Center claims systems
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 trials and mediations and assists with arbitrations, and depositions
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 and prepares roundtable reports and large loss reports to advise the Branch VPs and Underwriting Directors
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
Assigns and manages 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
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
Handles complex claims timely payments
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. Handles complex claims nationwide
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 complex casualty claims
Submits referrals to the Estimatics, Special Investigation, Subrogation, Medical Review Units, , Corporate Office Coverage Counsel and outside 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