Claims Adjuster II

2 days ago

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

EMC Insurance is seeking a highly skilled Claims Adjuster II to join our team. As a key member of our claims department, you will be responsible for investigating and evaluating complex auto and casualty claims. Your expertise will be essential in ensuring that our customers receive fair and timely resolutions to their claims.

Key Responsibilities
  • Investigate and evaluate complex auto and casualty claims
  • Review claim notices, contracts, and policies to verify coverage and deductibles
  • Communicate with insureds and claimants to explain the claim process and initiate investigations
  • Obtain statements from insureds, claimants, and witnesses and document summaries in the claims system
  • Request and analyze investigative reports and claim forms
  • Document claim activities, reserve analysis, and summaries of reports
  • Set timely and adequate reserves in compliance with company reserving philosophy and methodology
  • Identify and investigate opportunities for recovery and arrange evidence preservation in compliance with legal requirements
  • Adhere to state requirements regarding regulatory compliance
  • Handle litigated files of low complexity
  • Recommend and obtain authority for defense counsel and assign vendors for accuracy and appropriateness
  • Review bills, receipts, and litigation-related expenses for accuracy and appropriateness
  • Notify supervisors of claims that may need escalation or reassignment
  • Draft reservation of rights and coverage denial letters with supervisor approval
  • Provide prompt and detailed responses to agents, insureds, and claimants on the status of claims
  • Resolve questions of coverage, liability, and claim value and communicate with insureds and claimants to resolve claims in a timely manner
  • Prepare bodily injury and/or damage evaluations, negotiation ranges, and target settlement numbers prior to negotiation
  • Identify and protect all liens as appropriate
  • Investigate Medicare liens and resolve in accordance with EMC and Medicare guidelines
  • Communicate with insureds, claimants, and attorneys to negotiate the settlement of claims
  • Attend and assist with suits, mediations, and arbitrations
  • Prepare and issue settlement and release documents verifying accuracy and ensuring proper execution
  • Issue timely payments
  • Review and audit estimates written by independent adjusters, body shops, engineers, and other vendors for accuracy and to ensure the most cost-effective repair approach
  • Submit referrals to the Estimatics, Special Investigation, Subrogation, Medical Review Units, and Claims Legal as appropriate
  • Prepare risk reports for Underwriting and Risk Improvement
  • Review coverage intent and policy activity with Underwriting
  • Review account inspection information with Risk Improvement
  • Prepare claims and participate in claims roundtables to discuss unique cases to evaluate coverage, liability, and damage
  • Assist claims team members as appropriate in handling of claims
  • Participate in projects as assigned
  • Train and serve as a technical resource for team members
Requirements
  • Bachelor's degree or equivalent relevant experience
  • Three years of casualty claims adjusting experience or related experience
  • Relevant insurance designations preferred
Preferred Skills
  • 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 traveling
Compensation

The hiring range for this position is $62,000 - $80,000 per year, depending on location.

EMC Insurance is an equal opportunity employer and welcomes applications from diverse candidates. 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.

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