Specialty Casualty Claims Adjuster - Construction Defect

February 25

🌵 Arizona – Remote

Although this job is listed in Arizona, this company may be open to hiring remote in other states.

💵 $77k - $106.1k / year

⏰ Full Time

🟡 Mid-level

🟠 Senior

🔒 Insurance

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EMC Insurance Companies

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EMC Insurance Companies is a mutual insurance firm providing specialized business insurance solutions. They focus on commercial property insurance, liability insurance, workers' compensation, and business owners' policies. With a strong emphasis on personalized service, EMC collaborates closely with local agents to deliver comprehensive and tailored coverage. EMC is committed to understanding the unique challenges faced by its policyholders, offering risk management and loss control resources to help businesses safeguard their assets. Known for their dedicated partnerships and exceptional customer service, EMC ensures that businesses are prepared for the unexpected with their superior insurance solutions.

1001 - 5000 employees

Founded 1911

📋 Description

• Reviews and evaluates 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, and summaries of reports including Medicare (MSP) modules in the claim system • Sets and updates 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 • Recommends and obtains authority from Supervisor/Director in the assignment of defense counsel • Assigns and manages experts and third-party 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 • Assigns vehicle/property damage appraisals and vehicle rentals • 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 roundtable reports 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 • Assists with account servicing and marketing as necessary • Handles litigated claims files of moderate complexity • Analyzes lawsuits by reviewing facts and allegations to determine coverage. Prepares Reservation of Rights and coverage denial 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 • Negotiates claim settlements with plaintiff’s attorneys • Completes litigation matters in the appropriate claims system • Assigns files and collaborates with defense counsel on action plans and litigation strategy to manage litigation expenses and obtain favorable outcomes • Secures all necessary official reports, claim forms and documents • Reviews legal budget/invoices and litigation related expenses for accuracy and appropriateness • Identifies, investigates, and proactively pursues opportunities for recovery • Oversees suits, attends trials and mediations, and assists with mediations, depositions, and arbitrations

🎯 Requirements

• Bachelor’s degree or equivalent relevant experience • Five years of casualty claims adjusting experience or related experience, including at least one year of experience within assigned specialty line of business • 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 driving

🏖️ 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