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 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, and summaries of reports including Medicare (MSP) modules in the claim systemSets and updates timely, adequate reserves in compliance with the company reserving philosophy and methodologyIdentifies, 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 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 counselAssigns and manages experts and third-party vendors for accuracy and appropriateness with supervisory approval as appropriateReviews bills, receipts, legal invoices and litigation related expenses for accuracy and appropriatenessNotifies the people leader of claims that may need escalation or reassignmentDrafts reservation of rights and coverage denial letters with supervisor approvalAssigns vehicle / property damage appraisals and vehicle rentalsProvides prompt, detailed responses to agents, insureds and claimants on the status of claimsResolves 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 appropriate higher authority as requiredIdentifies 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 claimsAttends and assists with suits, mediations, and arbitrationsPrepares and issues settlement and release documents verifying accuracy and ensuring they are properly executedIssues timely paymentsReviews and audits estimates written by independent adjusters, body shops, engineers, and other vendors for accuracy and to ensure the most cost-effective repair approachSubmits referrals to the Estimatics, Special Investigation, Subrogation, Medical Review Units, and Claims Legal as appropriatePrepares risk reports for Underwriting and Risk ImprovementReviews coverage intent and policy activity with UnderwritingReviews account inspection information with Risk ImprovementPrepares roundtable reports and participates in claims roundtables to discuss unique cases to evaluate coverage, liability, and damageAssists claims team members as appropriate in handling of claimsParticipates in projects as assignedTrains, and serves as a technical resource for team membersAssists with account servicing and marketing as necessaryHandles litigated claims files of moderate complexityHandles litigated claims files of moderate complexityAnalyzes lawsuits by reviewing facts and allegations to determine coverage. Prepares Reservation of Rights and coverage denial letters if allegations warrantPrepares 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 attorneysCompletes litigation matters in the appropriate 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 trials and mediations, and assists with mediations, depositions, and arbitrationsEducation & Experience :
Bachelor's degree or equivalent relevant experienceFive years of casualty claims adjusting experience or related experience, including at least one year of experience within assigned specialty line of businessRelevant insurance designations preferredKnowledge, Skills & Abilities :
Strong knowledge of the theory and practice of the claim functionStrong knowledge of insurance contracts, medical terminology and substantive and procedural lawsStrong knowledge of computers and claims systemsAbility to obtain all applicable state licensesAbility to adhere to high standards of professional conduct and code of ethicsGood organizational and empathetic interpersonal skillsStrong written and verbal communication skillsStrong investigative and problem-solving abilitiesExcellent customer service skillsAbility to maintain confidentialityOccasional travel required; a valid driver's license with an acceptable motor vehicle report per company standards required if drivingOur 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.
