Senior Specialty Casualty Claims Adjuster - Construction Defect

Employers Mutual Casualty Co

280d • $83,925 - $115,647 • 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 in Western Region states.

Requirements

• Bachelor's degree or equivalent relevant experience.
• Seven years of casualty claims adjusting experience or related experience, including at least three years of experience within assigned specialty line of business.
• Relevant insurance designations preferred.

Nice To Haves

• Excellent knowledge of the theory and practice of the claim function.
• Excellent knowledge of insurance contracts, medical terminology and substantive and procedural laws.
• Strong knowledge of computers and claims systems.
• Ability to obtain all applicable state licenses.
• Ability to adhere to high standards of professional conduct and code of ethics.
• Excellent organizational and empathetic interpersonal skills.
• Strong written and verbal communication skills.
• Excellent investigative and problem-solving abilities.
• Excellent customer service skills.
• Ability to maintain confidentiality.

Responsibilities

• Promptly investigates and evaluates severe construction defect claims identified as complex per EMC's claims handling guidelines.
• Reviews and evaluates the claim notice, contracts, lawsuits, state statutes and policies to verify the appropriate coverage, deductibles, and payees.
• Investigates and evaluates severe specialty claims 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, and summaries of reports including Medicare (MSP) modules in the claim system.
• Sets and updates timely, adequate reserves in compliance with the company reserving philosophy and methodology.
• Drafts roundtable reports and prepares large loss reports as requested.
• Identifies, investigates, and proactively pursues opportunities for recovery including partnering with attorneys and/or other experts to arrange evidence preservation in legal compliance.
• Adheres to all state requirements regarding regulatory compliance by sending out letters/forms containing appropriate language according to timeliness.
• Reviews bills, receipts, legal invoices and litigation related expenses for accuracy and appropriateness.
• Assigns and manages experts and third-party vendors for accuracy and appropriateness with supervisory approval as appropriate.
• Drafts reservation of rights and coverage denial letters with supervisor approval.
• Assigns vehicle/property damage appraisals and vehicle rentals.
• Provides prompt, detailed responses to agents, insureds, and claimants on the status of claims.
• Handles litigated claims files of high complexity.
• 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 appropriate higher authority when required.
• Prepares and issues settlement and release documents verifying accuracy and ensuring they are properly executed.
• Issues timely payments.
• Reviews and audits estimates written by independent adjusters, engineers, and other vendors for accuracy and to ensure the most cost-effective repair approach.
• Prepares claims and participates in claims roundtables to discuss unique cases to evaluate coverage, liability, and damage.

Benefits

• Outstanding benefits with life, medical, dental, vision and prescription drug coverage.
• Competitive paid time off plan and a full day of volunteer time off annually.
• Financial incentives, including a 401(k) plan match, pension plan, OneEMC bonus plan and recognition and anniversary awards.
• Professional development and growth opportunities, including tuition reimbursement.
• Wellness initiatives to improve team member well-being and reduce health insurance costs.
• Flexibility to dress for your day and opportunities for alternative work arrangements.

What This Job Offers

• Job Type: Full-time
• Career Level: Mid Level
• Industry: Insurance Carriers and Related Activities
• Education Level: Bachelor's degree