Casualty Claims Adjuster II
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AI Summary
At EMC, we’re all about working together to make an impact. As part of our team, you’ll have the opportunity to grow, contribute, and gain experience that matters. We strive to be caring leaders, close partners, and responsive experts—always supporting each other to do our best work. Join us, and let’s improve lives together.
**This position is eligible to work from home anywhere in the United States**
Step into a role where your expertise directly drives meaningful outcomes, leveraging your investigative instincts, sound judgment, and negotiation skills to bring clarity and resolution to complex claims. In this position, you will make an immediate impact by confidently guiding claims from first notice through resolution, balancing thorough investigation with efficient, fair settlements. Your ability to interpret coverage, evaluate liability, and manage litigation will not only protect the organization but also deliver exceptional experiences to insureds and claimants. By collaborating cross-functionally and acting as a trusted partner to agents, vendors, and internal teams, you will play a critical role in reducing risk, controlling costs, and strengthening relationships while continuously elevating the quality and integrity of the claims process.
Essential Functions:
Investigates and evaluates moderately complex auto and casualty claims, confirming coverage, deductibles, and payees against policies and regulations
Initiates timely contact with insureds, claimants, and witnesses to explain the process and gather statements
Collects, reviews, and documents investigative reports, claim forms, and supporting materials in the claims system
Maintains accurate claim documentation, including activity logs, report summaries, and reserve analysis (including Medicare/MSP)
Establishes and adjusts timely, appropriate reserves in line with company methodology
Identifies and pursues subrogation and recovery opportunities, ensuring proper evidence handling and compliance
Ensures adherence to state regulatory requirements, including timely issuance of required communications and forms
Manages low-complexity litigated files, including recommending and coordinating defense counsel assignments
Oversees and evaluates vendors, invoices, and expenses for accuracy, appropriateness, and cost-effectiveness
Drafts coverage determinations, including reservation of rights and denial letters with appropriate approvals
Provides clear, timely status updates to agents, insureds, and claimants and escalates issues as needed
Evaluates liability and damages, prepares negotiation strategies, resolves liens (including Medicare), and negotiates settlements
Finalizes settlements, including documentation, releases, payments, and participation in mediations or arbitrations
Collaborates cross-functionally (SIU, Subrogation, Legal, Underwriting, Risk) while contributing to team support, training, and projects
Education & Experience:
Bachelor’s degree or equivalent relevant experience
Three years of casualty claims adjusting experience or related experience
Relevant insurance designations preferred
Knowledge, Skills, & Abilities:
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
The hiring salary range for this position will vary based on geographic location, falling within either of the following:
$60,813 - $84,038 or $67,200 - $92,395A hiring range represents a subset of the full salary range. The actual salary will depend on several factors, including relevant education, skills, and experience of an applicant, geographic location, and business needs.
For information relating to the benefits EMC Team Members receive as part of a comprehensive rewards package, please visit www.emcins.com/careers.
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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