Senior Claims Examiner

3 weeks ago

Iowa City, Iowa, United States EMC Insurance Full time
Job Summary

EMC Insurance is seeking a highly skilled Senior Casualty Claims Adjuster to join our team. As a key member of our claims department, you will be responsible for resolving complex claims and providing exceptional customer service.

Key Responsibilities
  • Review claim notices, lawsuits, contracts, and policies to verify coverage, deductibles, claim payee/mortgagees, and compensability
  • Initiate prompt contact with customers to obtain information on the claim and explain the claim process
  • Take statements from insureds/claimants/witnesses and document summaries within the claims system
  • Document handling activity, including Medicare (MSP) modules, in the claims system
  • Set timely, adequate reserves in compliance with the company reserving philosophy and methodology
  • Obtain authority in the selection of appropriate defense counsel for assignment based on the type of suit and complexity of the matter for litigated claims
  • Handle medium to lower complexity lawsuits
  • Resolve questions of coverage, liability, and the value of claims
  • Draft reservation of rights and denial letters when appropriate
  • Assign independent adjusters when necessary with supervisory approval
  • Secure all necessary official reports, claim forms, and documents
  • Review bills, invoices, and receipts for accuracy
  • Review legal invoices and litigation-related expenses for accuracy and appropriateness
  • Provide prompt, detailed responses to agents, insureds, and claimants on the status of claims
  • Identify, investigate, and proactively pursue opportunities for recovery
  • Prepare bodily injury and/or property damage evaluations, analyze negotiation ranges, and target settlement numbers prior to negotiation
  • Communicate with insureds/claimants/attorneys to negotiate the settlement of claims
  • Assist in suits, mediations, arbitrations, and attending depositions
  • Participate in Claims roundtables
  • Issue settlement documents and verify that they are properly executed
  • Issue timely payments within check authority limit
  • Investigate Medicare liens and timely resolve in accordance with EMC and Medicare guidelines
  • Submit referrals to the Estimatics Review, Special Investigation, Property Review, Subrogation, Corporate Office Coverage Counsel, and Medical Review Units, when necessary
  • Prepare risk reports for Underwriting
  • Review coverage intent and policy activity with Underwriting
  • Review account inspection information with Risk Improvement
  • Assist own branch claims team members as needed. Act as a mentor/coach for less experienced branch claims team members. Assist other branches in handling of claims (due to storms or temporary staffing gaps) through Resource Sharing Program. Participate in branch and department projects.
Requirements
  • Bachelor's degree or equivalent relevant experience
  • Five years of claims adjusting experience
  • Attainment of all applicable state licenses within six months of hire
  • Relevant insurance designations preferred
Preferred Qualifications
  • Proven, excellent knowledge of the theory and practice of the claim function
  • Analytical ability and sound judgment with respect to liability and coverage
  • Strong knowledge of insurance contracts, medical terminology, and legal aspects of court procedures
  • High standards of professional conduct
  • Strong knowledge of computers and claims systems
  • Strong organizational and written and verbal communication skills
  • Excellent investigative and problem-solving abilities
EMC Insurance is an Equal Opportunity Employer

EMC Insurance is committed to diversity and inclusion in the workplace. We are an equal opportunity employer and welcome applications from diverse candidates. We are proud to be an inclusive and supportive workplace where everyone has the opportunity to succeed.

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