EMC Insurance Companies

Casualty Claims Adjuster I

EMC Insurance Companies

full-time

Posted on:

Location Type: Remote

Location: United States

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Salary

💰 $55,795 - $77,098 per year

Job Level

Junior

About the role

  • Reviews the claim notice, contracts, state statutes and policies to verify the appropriate coverage, deductibles, and payees
  • 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
  • Request and analyze 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 timely, adequate reserves in compliance with the company reserving philosophy and methodology
  • Identifies, investigates, and proactively pursues opportunities for recovery including arranging 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
  • Reviews bills, invoices and receipts for accuracy and appropriateness
  • Notifies people leader of claims that may need escalation or reassignment
  • Drafts reservation of rights and coverage denial letters with supervisor approval
  • Assigns vehicle/property damage appraisals and vehicle rentals
  • Makes recommendations to people leader on the assignment of independent adjusters
  • 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 authority when required
  • Identifies and protects all liens as appropriate
  • Investigates Medicare liens and resolves issues 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
  • Issues timely payments
  • Reviews and audits estimates written by independent adjusters for accuracy and to ensure the most cost-effective repair approach
  • Submits referrals to the Estimatics, Special Investigation, Subrogation, Medical Review Units and Claims Legal teams as appropriate
  • Prepares risk reports for Underwriting and Risk Improvement
  • Prepares claims and participates in claims roundtables to discuss unique cases to evaluate coverage and damage

Requirements

  • Bachelor’s degree or equivalent relevant experience
  • One year of casualty claims adjusting experience or related experience
  • Relevant insurance designations preferred
  • Good knowledge of the theory and practice of the claim function
  • Good 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
  • Good organizational and empathetic interpersonal skills
  • Strong written and verbal communication skills
  • Good investigative and problem-solving abilities
  • Excellent customer service skills
  • Ability to maintain confidentiality
  • Occasional travel required; a valid driver’s license with an acceptable motor vehicle report per company standards required if traveling
Benefits
  • Health insurance
  • 401(k) matching
  • Flexible work hours
  • Paid time off
  • Professional development opportunities
  • Employee wellness programs
  • Volunteer time off
  • Life insurance
  • Dental and vision coverage
Applicant Tracking System Keywords

Tip: use these terms in your resume and cover letter to boost ATS matches.

Hard Skills & Tools
casualty claims adjustingclaims investigationreserve analysisMedicare guidelinesnegotiationclaims documentationinsurance contractsmedical terminologyregulatory complianceevidence preservation
Soft Skills
organizational skillsinterpersonal skillswritten communicationverbal communicationproblem-solvingcustomer serviceempathyprofessional conductconfidentialityethical standards
Certifications
Bachelor’s degreeinsurance designationsstate licenses