Claims Specialist

At EMC, we’re all about working together to make an impact. As part of our team, you’ll have the opportunity to grow, contribute, and gain experience that matters. We strive to be caring leaders, close partners, and responsive experts—always supporting each other to do our best work. Join us, and let’s improve lives together.

1.     Investigates and evaluates multi-line and multi-state claims and losses of severe complexity:

·                Analyzes coverage to ensure loss is covered by client policy

·                Initiates contact within 24-hours for both clients and claimants for general liability claims as well as employee, client and medical providers for worker’s compensation claims

·                Completes thorough investigation by determining facts of loss and taking statements from client, claimants, injured workers, and witnesses

·                Analyzes loss details and develops a plan of action to efficiently and accurately manage outstanding issues and achieve resolution on claims presented

·                Sets timely, adequate reserves to cover client probable exposure in accordance with specific client claim handling procedures

·                Analyzes collected medical records to evaluate injury as a factor in the determination of compensability and ongoing medical management

·                Reviews bills, invoices and receipts for accuracy and processing

·                Identifies risk factors and determines if referral for additional handling such as Estimatics Review Unit, Special Investigation Unit, Subrogation, or Medical Review, is necessary (with client approval)

·                Investigates subrogation potential on every claim which includes review of police and fire department reports and pursues recovery accordingly

·                Prepares information for jurisdictional state filings for workers’ compensation claims 

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2.     Negotiates, settles and/or resolves complex claims:

• Responds to questions from clients, agents, claimants, attorneys or coworkers
• Investigates and resolves questions of coverage, liability and the value of claims and losses
• Issues denial letters when appropriate
• Negotiates settlement amounts for damages claimed within assigned authority limits. Makes recommendations to management for settlement amounts outside of authority limits, and follows case to conclusion for training purposes as appropriate Issues payments within check authority limit
• Issues settlement documents and verifies that they are properly executed
• Prepares bodily injury and/or property damage evaluations, negotiation ranges and target settlement numbers
• Performs Medicare compliance functions
• Collaborates with and directs defense counsel in the handling of lawsuits
• Guides clients through claim litigation strategies
• Authorizes and approves payments of defense attorney fees

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3.     Anticipates customer needs, communicates decisions, defines expectations and fulfills commitments to involved parties:

• Maintains active diaries and a plans of action in line with client handling instructions
• Promptly responds to all inquiries
• Conducts personal consultation with clients. 
• Coordinates resources with vendors to address client needs
• Prepares claims summary reports for clients and participates in file reviews
• Refers requests for account inquiries to Claims Management
• Prepares mandatory reporting for excess carriers according to defined carrier reporting requirements

·                Participates in internal and external training opportunities for the specific line of business

·                Researches and analyzes client-specific trends in claims/settlements

4.     Training

• Remains current on jurisdictional and industry related developments within the respective lines of business through internal and external training opportunities
• Ensure all continuing education units (CEU’s) and professional licenses are kept up to date as per requirements of the relevant jurisdictions
• Serves as a subject matter expert for other Claims Solutions team members
• Provides guidance to team members with technical issues of a claim and answers questions on coverage, compensability, investigations and plans of action

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.

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