![]() ![]() Occasional travel required a valid driver's license with an acceptable motor vehicle report per company standards required if traveling.Strong investigative and problem-solving abilities.Strong written and verbal communication skills.Good organizational and empathetic interpersonal skills.Ability to adhere to high standards of professional conduct and code of ethics.Ability to obtain all applicable state licenses.Strong knowledge of computers and claims systems.Strong knowledge of insurance contracts, medical terminology and substantive and procedural laws.Strong knowledge of the theory and practice of the claim function.Relevant insurance designations preferred.Three years of casualty claims adjusting experience or related experience.Bachelor's degree or equivalent relevant experience.Trains, and serves as a technical resource for team members.Assists claims team members as appropriate in handling of claims.Prepares claims and participates in claims roundtables to discuss unique cases to evaluate coverage, liability, and damage.Reviews account inspection information with Risk Improvement.Reviews coverage intent and policy activity with Underwriting.Prepares risk reports for Underwriting and Risk Improvement.Submits referrals to the Estimatics, Special Investigation, Subrogation, Medical Review Units and Claims Legal as appropriate.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.Prepares and issues settlement and release documents verifying accuracy and ensuring they are properly executed.Attends and assists with suits, mediations, and arbitrations.Communicates with insureds, claimants, and attorneys to negotiate the settlement of claims.Investigates Medicare liens and timely resolve in accordance with EMC and Medicare guidelines.Identifies and protects all liens as appropriate.Obtains appropriate higher authority as required Prepares bodily injury and/or damage evaluations, negotiation ranges and target settlement numbers prior to negotiation.Resolves questions of coverage, liability and the value of the claims and communicates with insureds and claimants to resolve claims in a timely manner.Provides prompt, detailed responses to agents, insureds and claimants on the status of claims.Drafts reservation of rights and coverage denial letters with supervisor approval.Notifies the people leader of claims that may need escalation or reassignment.Reviews bills, receipts, legal invoices and litigation related expenses for accuracy and appropriateness.Assigns and manages vendors for accuracy and appropriateness with supervisory approval as appropriate.Recommends and obtains authority from appropriate people leader in the assignment of defense counsel.Handles litigated files of low complexity.Adheres to all state requirements regarding regulatory compliance by sending out letters/forms containing appropriate language according to timelines.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.Sets timely, adequate reserves in compliance with the company reserving philosophy and methodology.Documents claim activities, reserve analysis, summaries of reports including Medicare (MSP) modules in the claim system.Request and analyze investigative and other relevant reports, claim forms and documents when appropriate.Obtains statements from insureds, claimants, and witnesses and documents summaries within the claims system.Initiates timely contact with insureds and claimants to explain the claim process and initiate the investigation.Reviews the claim notice, contracts, state statutes and policies to verify the appropriate coverage, deductibles, and payees.Promptly investigates and evaluates moderately complex auto and casualty claims.*THIS POSITION IS ELIGIBLE TO WORK REMOTELY FROM TN, FL,AL, NC, SC, OH, KY, IN, GA, PA, ME, RI, NH, DE, MI, NJ, NY, CT, VT, MA* Essential Functions: EMC strives to hire and retain the best people by engaging, developing and rewarding employees. You can count on gaining valuable experience while contributing to the company's success. At EMC, you'll put your skills to good use as an important member of our team. ![]()
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