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: • Bachelor’s 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 driver’s 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

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