Casualty Claims Adjuster II
Description:
Promptly investigates and evaluates moderately complex auto and casualty claims
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, 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
Handles litigated files of low complexity
Recommends and obtains authority from appropriate people leader in the assignment of defense counsel
Assigns and manages vendors for accuracy and appropriateness with supervisory approval as appropriate
Reviews bills, receipts, legal invoices and litigation related expenses for accuracy and appropriateness
Notifies the people leader of claims that may need escalation or reassignment
Drafts reservation of rights and coverage denial letters with supervisor approval
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 appropriate higher authority as required
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
Attends and assists with suits, mediations, and arbitrations
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, body shops, engineers, and other vendors 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 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, liability, and damage
Assists claims team members as appropriate in handling of claims
Participates in projects as assigned
Trains, and serves as a technical resource for team members
Requirements:
Bachelors degree or equivalent relevant experience
Three years of casualty claims adjusting experience or related experience
Relevant insurance designations preferred
Strong knowledge of the theory and practice of the claim function
Strong 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
Strong investigative and problem-solving abilities
Excellent customer service skills
Ability to maintain confidentiality
Occasional travel required; a valid drivers license with an acceptable motor vehicle report per company standards required if traveling
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
Apply Now
Promptly investigates and evaluates moderately complex auto and casualty claims
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, 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
Handles litigated files of low complexity
Recommends and obtains authority from appropriate people leader in the assignment of defense counsel
Assigns and manages vendors for accuracy and appropriateness with supervisory approval as appropriate
Reviews bills, receipts, legal invoices and litigation related expenses for accuracy and appropriateness
Notifies the people leader of claims that may need escalation or reassignment
Drafts reservation of rights and coverage denial letters with supervisor approval
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 appropriate higher authority as required
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
Attends and assists with suits, mediations, and arbitrations
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, body shops, engineers, and other vendors 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 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, liability, and damage
Assists claims team members as appropriate in handling of claims
Participates in projects as assigned
Trains, and serves as a technical resource for team members
Requirements:
Bachelors degree or equivalent relevant experience
Three years of casualty claims adjusting experience or related experience
Relevant insurance designations preferred
Strong knowledge of the theory and practice of the claim function
Strong 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
Strong investigative and problem-solving abilities
Excellent customer service skills
Ability to maintain confidentiality
Occasional travel required; a valid drivers license with an acceptable motor vehicle report per company standards required if traveling
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
Apply Now