Complex Casualty Claims Specialist

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**

Manages litigation of severely complex claims.  Promptly investigates and evaluates severely complex auto and casualty claims identified as complex per EMC’s claims handling guidelines.  Sets and updates timely, adequate reserves in compliance with the company reserving philosophy and methodology.  Negotiates, settles and/or resolves severely complex claims.

Essential Functions:

• Manages litigation of severely complex claims

• Analyzes lawsuits by reviewing facts and allegations to determine coverage. Prepares any Reservation of Rights letters and coverage position letters if warranted

• Prepares lawsuit analysis and formalizes plan to discuss with management

• Collaborates with defense counsel and others to prepare bodily injury and/or damage evaluations, negotiation ranges and target settlement numbers prior to negotiation. Obtains higher authority when appropriate

• Negotiates claim settlements with plaintiff’s attorneys

• Completes litigation matters in CLMS and Claims Center claims systems

• Assigns files and collaborates with defense counsel on action plans and litigation strategy to manage litigation expenses and obtain favorable outcomes

• Reviews 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

• 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, summaries of reports including Medicare (MSP) modules in the claim system

• Prepares claims and participates in claims roundtables to discuss unique cases to evaluate coverage, liability, and damages

• 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 higher authority when appropriate

• 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

• Provides guidance to team members with technical issues of a claim and answers questions on coverage, compensability, investigations and plans of action.

• Serves as a subject matter expert for other claims team members.  Handles complex claims nationwide

• Prepares risk reports for Underwriting and Risk Improvement

• Reviews coverage intent and policy activity with Underwriting

Education & Experience:

• Bachelor’s degree or equivalent relevant experience

• Ten years of casualty claims adjusting experience or related experience

• Relevant insurance designations preferred

Knowledge, Skills, & Abilities:

• Superior knowledge of best claims practices used to resolve the most serious and complex liability claims

• Advanced knowledge of insurance contracts, medical terminology and substantive and procedural laws

• Excellent knowledge of negotiation and alternative resolution techniques

• Excellent 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

• Exceptional organizational and empathetic interpersonal skills.

• Thorough written and verbal communication skills

• Advanced customer service skills

• Ability to maintain confidentiality

• Thorough investigative and problem-solving abilities.

• Frequent travel required nationwide; 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 $105,211.24 - $135,116.83. 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.