Claims Adjuster
4 weeks ago
Job Summary:
As a Casualty Claims Adjuster I at EMC Insurance, you will play a critical role in investigating, negotiating, and resolving auto and casualty claims of moderate complexity. You will work independently, exercising sound judgment and adhering to the company's Claims Guide. Your strong communication skills will enable you to effectively interact with insureds, claimants, vendors, and agents, providing timely and detailed responses to their inquiries.
Key Responsibilities:
- Review claim notices, contracts, state statutes, and policies to verify coverage, deductibles, and payees.
- Initiate timely contact with insureds and claimants to explain the claim process and initiate investigation.
- Obtain statements from insureds, claimants, and witnesses, and document summaries within the claims system.
- Request and analyze investigative and other relevant reports, claim forms, and documents when appropriate.
- Identify, investigate, and proactively pursue opportunities for recovery, including arranging evidence preservation in compliance with legal requirements.
- Adhere to state requirements regarding regulatory compliance by sending out letters/forms containing appropriate language according to timelines.
- Draft reservation of rights and coverage denial letters with supervisor approval.
- Assign vehicle/property damage appraisals and vehicle rentals.
- Make recommendations to the people leader on the assignment of independent adjusters.
- Provide prompt, detailed responses to agents, insureds, and claimants on the status of claims.
- Resolve questions of coverage, liability, and the value of claims 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. Obtain authority when required.
- Identify and protect all liens as appropriate.
- Investigate Medicare liens and resolve issues in accordance with EMC and Medicare guidelines.
- Prepare and issue settlement and release documents verifying accuracy and ensuring they are properly executed.
- Review and audit estimates written by independent adjusters 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 teams as appropriate.
- Prepare claims and participate in claims roundtables to discuss unique cases to evaluate coverage and damage.
Requirements:
- Bachelor's degree or equivalent relevant experience.
- One year of casualty claims adjusting experience or related experience.
- Relevant insurance designations preferred.
Preferred Skills:
- Good knowledge of the theory and practice of the claim function.
- Good 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.
- Good 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.
EMC Insurance is an Equal Opportunity Employer.
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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