Specialty Casualty Claims Adjuster-Linebacker and Law Enforcement Liability

At EMC, you'll put your skills to good use as an important member of our team. You can count on gaining valuable experience while contributing to the company's success. EMC strives to hire and retain the best people by engaging, developing and rewarding employees.

**This position is eligible to work from home anywhere in the United States.

Candidates who exceed minimum qualifications may be considered for a higher level position.)**

Essential Functions:

• Reviews and evaluates 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
• 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
• 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
• Assigns and manages experts and third-party vendors for accuracy and appropriateness with supervisory approval as appropriate
• Reviews bills, receipts, legal invoices and litigation related expenses for accuracy and appropriateness
• Assigns vehicle/property damage appraisals and vehicle rentals
• 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 roundtable reports and participates in claims roundtables to discuss unique cases to evaluate coverage, liability, and damage
• Handles litigated claims files of moderate complexity
• Analyzes lawsuits by reviewing facts and allegations to determine coverage.  Prepares Reservation of Rights and coverage denial letters if allegations warrant
• Assigns files and collaborates with defense counsel on action plans and litigation strategy to manage litigation expenses and obtain favorable outcomes

Education & Experience:

• Bachelor’s degree or equivalent relevant experience
• Five years of casualty claims adjusting experience or related experience, including at least one year of experience within assigned specialty line of business
• Relevant insurance designations preferred

Knowledge, Skills & Abilities:

• 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 driver’s license with an acceptable motor vehicle report per company standards required if driving

 Per the Colorado Equal Pay for Equal Work Act, the hiring range for this position for Colorado-based team members is $82,757.51 - $106,263.54. The hiring range for other locations may vary.

Our employment practices are in accordance with the laws that prohibit discrimination due to race, color, creed, sex, sexual orientation, gender identity, genetic information, religion, age, national origin or ancestry, physical or mental disability, medical condition, veteran status, active military status, citizenship status, marital status or any other consideration made unlawful by federal, state, or local laws.

All of our locations are tobacco free including in company vehicles.