What are the responsibilities and job description for the Specialty Casualty Claims Adjuster- Construction Defect position at EMC Insurance Companies?
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 in Western Region states
Essential Functions :
Reviews and evaluates 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, 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
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
Recommends and obtains authority from Supervisor / Director in the assignment of defense counsel
Assigns and manages experts and third-party 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
Assigns vehicle / property damage appraisals and vehicle rentals
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 roundtable reports 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
Assists with account servicing and marketing as necessary
Handles litigated claims files of moderate complexity
Handles litigated claims files of moderate complexity
Analyzes lawsuits by reviewing facts and allegations to determine coverage. Prepares 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 appropriate 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 and mediations, and assists with mediations, depositions, and arbitrations
Education & Experience :
Bachelor’s degree or equivalent relevant experience
Five years of casualty claims adjusting experience or related experience, including at least one year of experience within assigned specialty line of business
Relevant insurance designations preferred
Knowledge, Skills & Abilities :
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 driving
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