Job Description
Casualty Claims Specialist- Construction Defect
remote type
Remote
locations
Colorado – Work From Home
time type
Full time
job requisition id
R4913
At EMC, you’ll put your skills to good use as an important member of our team. You can count on gaining valuable experience while contributing to the company’s success. EMC strives to hire and retain the best people by engaging, developing and rewarding employees.
This position can be performed remotely for candidates who reside in TX, OK, KS, NE, SD, ND, NM, AZ, CO, UT, WY, MT, NV, CA, OR, ID, or WA.
Essential Functions:
- Reviews the claim notice, contracts, state statutes and policies to verify the appropriate coverage, deductibles, and payees
- Investigates and evaluates complex coverage issues to determine applicable coverage, partnering with EMC Coverage Counsel and/or outside counsel as appropriate
- 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
- Requests and analyzes 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 partnering with attorneys and/or other experts to arrange 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
- Recommends and obtains authority from Supervisor/Director in the assignment of defense counsel
- Notifies people leader of claims that may need escalation or reassignment
- Assign and manage experts and third party vendors for accuracy and appropriateness with supervisory approval as required
- Provides prompt, detailed responses to agents, insureds and claimants on the status of claims
- Manages litigation of moderate to complex claims
- Analyzes lawsuits by reviewing facts and allegations to determine coverage. Prepares any Reservation of Rights letters if allegations warrant
- Prepares lawsuit analysis and formalizes plan to discuss with management
- Collaborates with defense counsel and others to prepare bodily injury and/or damage evaluations, negotiation ranges and target settlement numbers prior to negotiation. Obtains higher authority when appropriate
- Reviews legal budget/invoices and litigation related expenses for accuracy and appropriateness
- Oversees suits, attends and assists with mediations, arbitrations, and depositions
- 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 higher authority when appropriate
- 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
- Prepares and issues settlement and release documents verifying accuracy and ensuring they are properly executed
- Reviews and audits estimates written by independent adjusters, engineers and other vendors for accuracy and to ensure the most cost-effective repair approach
- Issues timely payments
- Provides guidance to team members with technical issues of a claim and answers questions on coverage, compensability, investigations and plans of action.
- Prepares claims and participates in claims roundtables to discuss unique cases to evaluate coverage and damage
Education & Experience:
- Bachelor’s degree or equivalent relevant experience
- Eight years of casualty claims adjusting experience or related experience
- Relevant insurance designations preferred
Knowledge, Skills & Abilities:
- Superior knowledge of best claims practices used to resolve the most serious and complex liability claims
- Advanced knowledge of insurance contracts, medical terminology and substantive and procedural laws
- Excellent 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
- Exceptional organizational and empathetic interpersonal skills.
- Thorough written and verbal communication skills
- Advanced customer service skills
- Ability to maintain confidentiality
- Thorough investigative and problem-solving abilities.
- Occasional travel required; a valid driver’s license with an acceptable motor vehicle report per company standards required if driving