Senior Specialty Casualty Claims Adjuster- Environmental

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**

Essential Functions

• Reviews and evaluates the claim notice, contracts, lawsuits, state statutes and policies to verify the appropriate coverage, deductibles, and payees
• Investigates and evaluates severe specialty claims 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, 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
• Drafts roundtable reports and prepares large loss reports as requested
• Identifies, investigates, and proactively pursues opportunities for recovery including partnering with attorneys and/or other experts to arrange 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 timeliness
• Recommends and obtains authority from appropriate people leader in the assignment of defense counsel
• Reviews bills, receipts, legal invoices and litigation related expenses for accuracy and appropriateness
• 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 appropriate
• Drafts reservation of rights and coverage denial letters with supervisor approval
• Assigns vehicle/property damage appraisals and vehicle rentals
• Provides prompt, detailed responses to agents, insureds, and claimants on the status of claims
• Handles litigated claims files of high complexity
• Analyzes lawsuits by reviewing facts and allegations to determine coverage. Prepares any Reservation of Rights and coverage denial letters if allegations warrant
• 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 the applicable claims system
• 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, depositions, and mediations, and assists with mediations and arbitrations
• 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 when 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
• Prepares and issues settlement and release documents verifying accuracy and ensuring they are properly executed
• Issues timely payments
• Submits referrals to the Estimatics, Special Investigation, Subrogation, Medical Review Units, and Claims Legal
• Reviews and audits estimates written by independent adjusters, engineers, and other vendors for accuracy and to ensure the most cost-effective repair approach
• 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
• Acts as a technical resource for less experienced claims adjusters, providing guidance on claims handling practice. Assists other claims professions with problematic claims as necessary
• Assists with account servicing and marketing as necessary

 
Education & Experience

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

 
Knowledge, Skills & Abilities

• Excellent knowledge of the theory and practice of the claim function
• Excellent 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
• Excellent organizational and empathetic interpersonal skills.
• Strong written and verbal communication skills.
• Excellent 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 $90,201.12- $115,826.23. 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.