Complex Casualty Claims Specialist

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**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:

Litigation Management

• 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

• Secures all necessary official reports, claim forms and documents

• Reviews legal budget, invoices, and litigation related expenses for accuracy and appropriateness

• Identifies, investigates, and proactively pursues opportunities for recovery

• Oversees suits, attends trials and mediations and assists with arbitrations, and depositions

Promptly investigates and evaluates claims of severe complexity:

• 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

• Sets timely, adequate reserves in compliance with the company reserving philosophy and methodology and prepares roundtable reports and large loss reports to advise the Branch VPs and Underwriting Directors

• Identifies, investigates, and proactively pursues opportunities for recovery including partnering with attorneys and/or other experts to arrange 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

• Recommends and obtains authority from Supervisor/Director in the assignment of defense counsel

• Notifies people leader of claims that may need escalation or reassignment

• Assigns and manages experts and third-party vendors for accuracy and appropriateness with supervisory approval as required

• Drafts reservation of rights and denial letters when appropriate

• Provides prompt, detailed responses to agents, insureds and claimants on the status of claims

Negotiates, settles and/or resolves 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 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

• Prepares and issues settlement and release documents verifying accuracy and ensuring they are properly executed

• Reviews and audits estimates written by independent adjusters, engineers and other vendors for accuracy and to ensure the most cost-effective repair approach

• Handles complex claims timely payments

Serves as a technical resource for team members:

• 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

• Acts as a technical resource to other claims professionals providing guidance on claims handling practice.  Assists other claims professionals with complex or problematic claims as necessary

• Leads and/or participates in claims projects as a representative of complex casualty claims

Collaboration:

• Submits referrals to the Estimatics, Special Investigation, Subrogation, Medical Review Units, , Corporate Office Coverage Counsel and outside coverage counsel 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 and damage

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

The hiring salary range for this position will vary based on geographic location, falling within either of the following:

A hiring range represents a subset of the full salary range. The actual salary will depend on several factors, including relevant education, skills, and experience of an applicant, geographic location, and business needs.

For information relating to the benefits EMC Team Members receive as part of a comprehensive rewards package, please visit www.emcins.com/careers.

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.

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