Senior Casualty Claims Adjuster

EMC Insurance Companies

11d•$72,726 - $109,786•Remote

About The Position

The Senior Casualty Claims Adjuster reviews and handles casualty claims, including medium- to lower-complexity lawsuits. The role evaluates coverage, liability, and claim value; sets reserves; investigates claims; negotiates settlements; coordinates litigation and related reviews; and communicates claim status to agents, insureds, claimants, and attorneys. The adjuster also supports branch claims teams, mentors less experienced team members, and may assist other branches through the Resource Sharing Program. This position is eligible to work from home anywhere in the United States and requires travel.

Requirements

Bachelor’s degree or equivalent relevant experience.
Five years of claims adjusting experience.
Attain all applicable state licenses within six months of hire.
Proven, excellent knowledge of the theory and practice of the claim function.
Analytical ability and sound judgment regarding liability and coverage.
Strong knowledge of insurance contracts, medical terminology, and legal aspects of court procedures.
High standards of professional conduct.
Strong knowledge of computers and claims systems.
Strong organizational, written, and verbal communication skills.
Excellent investigative and problem-solving abilities.
Travel is required; if traveling, a valid driver’s license and an acceptable motor vehicle report under company standards are required.

Nice To Haves

Relevant insurance designations are preferred.

Responsibilities

Review claim notices, lawsuits, contracts, and policies to verify coverage, deductibles, claim payees or mortgagees, and compensability.
Contact customers promptly to obtain claim information and explain the claims process.
Take statements from insureds, claimants, and witnesses, and document summaries in the claims system.
Document claims-handling activity, including Medicare (MSP) modules, in the claims system.
Set timely and adequate reserves in accordance with company reserving philosophy and methodology.
Obtain authority to select appropriate defense counsel for litigated claims based on suit type and complexity.
Handle medium- to lower-complexity lawsuits.
Resolve questions concerning coverage, liability, and claim value.
Draft reservation-of-rights and denial letters when appropriate.
Assign independent adjusters when necessary, with supervisory approval.
Secure necessary official reports, claim forms, and documents.
Review bills, invoices, and receipts for accuracy, and review legal invoices and litigation expenses for accuracy and appropriateness.
Provide agents, insureds, and claimants with prompt, detailed claim-status responses.
Identify, investigate, and proactively pursue recovery opportunities.
Prepare bodily injury and/or property damage evaluations, analyze negotiation ranges, and establish target settlement numbers before negotiations.
Communicate with insureds, claimants, and attorneys to negotiate claim settlements.
Assist with suits, mediations, and arbitrations, and attend depositions.
Participate in Claims roundtables.
Issue settlement documents and verify proper execution.
Issue timely payments within check authority limits.
Investigate Medicare liens and resolve them promptly in accordance with EMC and Medicare guidelines.
Submit referrals to Estimatics Review, Special Investigation, Property Review, Subrogation, Corporate Office Coverage Counsel, and Medical Review Units when necessary.
Prepare risk reports for Underwriting.
Review coverage intent and policy activity with Underwriting.
Review account inspection information with Risk Improvement.
Assist branch claims team members as needed and mentor or coach less experienced team members.
Assist other branches with claims during storms or temporary staffing gaps through the Resource Sharing Program.
Participate in branch and department projects.