Casualty Claims Adjuster II

Description:
? Promptly investigates and evaluates moderately complex auto and casualty claims
? Reviews the claim notice, contracts, state statutes and policies to verify the appropriate coverage, deductibles, and payees
? 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
? Request and analyze investigative and other relevant reports, claim forms and documents when appropriate
? Documents claim activities, reserve analysis, summaries of reports including Medicare (MSP) modules in the claim system
? Sets 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
? Handles litigated files of low complexity
? Recommends and obtains authority from appropriate people leader in the assignment of defense counsel
? Assigns and manages 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
? 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 claims 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

Requirements: ? Bachelor?s degree or equivalent relevant experience ? Three years of casualty claims adjusting experience or related experience ? Relevant insurance designations preferred ? 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

Benefits:
? Outstanding benefits with life, medical, dental, vision and prescription drug coverage
? Competitive paid time off plan and a full day of volunteer time off annually
? Financial incentives, including a 401(k) plan match, pension plan, OneEMC bonus plan and recognition and anniversary awards
? Professional development and growth opportunities, including tuition reimbursement
? Wellness initiatives to improve team member well-being and reduce health insurance costs
? Flexibility to dress for your day and opportunities for alternative work arrangements

Apply Job!

For more such jobs please click here!