Casualty 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. This position is eligible to work from home anywhere in the US** The Casualty Claims Specialist exercises independent judgment in the investigation, negotiation, and disposition of auto and casualty claims of severe complexity, including claims in litigation, within limitations of authority outlined in the Claims Guide. Maintains and reinforces department procedures. Communicates effectively with insureds, claimants, vendors, and agents, regarding coverage, claims status and other claims questions. Essential Functions Promptly investigates and evaluates claims of severe complexity: Reviews the claim notice, contracts, state statutes and policies to verify the appropriate coverage, deductibles, and payeesInvestigates and evaluates complex coverage issues to determine applicable coverage, partnering with EMC Coverage Counsel and/or outside counsel as appropriateInitiates timely contact with insureds and claimants to explain the claim process and initiate the investigationObtains statements from insureds, claimants, and witnesses and documents summaries within the claims systemRequests and analyzes investigative and other relevant reports, claim forms and documents when appropriateDocuments claim activities, reserve analysis, summaries of reports including Medicare (MSP) modules in the claim systemPrepares claims and participates in claims roundtables to discuss unique cases to evaluate coverage, liability, and damagesSets timely, adequate reserves in compliance with the company reserving philosophy and methodologyIdentifies, 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 evidenceAdheres to all state requirements regarding regulatory compliance by sending out letters/forms containing appropriate language according to timelinesRecommends and obtains authority from Supervisor/Director in the assignment of defense counselNotifies people leader of claims that may need escalation or reassignmentAssign and manage experts and third party vendors for accuracy and appropriateness with supervisory approval as requiredDrafts reservation of rights and denial letters when appropriateProvides prompt, detailed responses to agents, insureds and claimants on the status of claims Litigation Management Manages litigation of moderate to complex claimsAnalyzes lawsuits by reviewing facts and allegations to determine coverage. Prepares any Reservation of Rights letters if allegations warrant· Prepares lawsuit analysis and formalizes plan to discuss with managementCollaborates 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 appropriateNegotiates claim settlements with plaintiff’s attorneys· Completes litigation matters in CLMS claims systemAssigns files and collaborates with defense counsel on action plans and litigation strategy to manage litigation expenses and obtain favorable outcomesSecures all necessary official reports, claim forms and documentsReviews legal budget/invoices and litigation related expenses for accuracy and appropriatenessIdentifies, investigates, and proactively pursues opportunities for recoveryOversees suits, attends and assists with mediations, arbitrations, and depositions 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 mannerPrepares bodily injury and/or damage evaluations, negotiation ranges and target settlement numbers prior to negotiation. Obtains higher authority when appropriateIdentifies and protects all liens as appropriateInvestigates Medicare liens and timely resolve in accordance with EMC and Medicare guidelinesCommunicates with insureds, claimants, and attorneys to negotiate the settlement of claimsPrepares and issues settlement and release documents verifying accuracy and ensuring they are properly executedReviews and audits estimates written by independent adjusters, engineers and other vendors for accuracy and to ensure the most cost-effective repair approachIssues 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. Assists in handling of claims or suits outside of their jurisdiction.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 casualty claims Collaboration Submits referrals to the Estimatics, Special Investigation, Subrogation, Medical Review Units, and Corporate Office Coverage Counsel as appropriatePrepares 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 experienceEight years of casualty claims adjusting experience or related experienceRelevant insurance designations preferred Knowledge, Skills & Abilities Superior knowledge of best claims practices used to resolve the most serious and complex liability claimsAdvanced knowledge of insurance contracts, medical terminology and substantive and procedural lawsExcellent knowledge of computers and claims systems.Ability to obtain all applicable state licensesAbility to adhere to high standards of professional conduct and code of ethicsExceptional organizational and empathetic interpersonal skills.Thorough written and verbal communication skillsAdvanced customer service skillsAbility to maintain confidentialityThorough investigative and problem-solving abilities.Occasional travel required; 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: $78,726 - $108,771 or $87,008 - $119,646 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.