Casualty Claims Adjuster II

This is a fully remote position, open to applicants in United States.

📋 Description

• Conduct investigations and assessments of moderately complex auto and casualty claims.

• Verify coverage, deductibles, and payees in accordance with policies and regulations.

• Reach out to insured parties, claimants, and witnesses to clarify the process and collect statements.

• Gather, evaluate, and document investigative reports, claim forms, and supporting documentation.

• Maintain comprehensive claim records, activity logs, report summaries, and reserve analyses, including Medicare/MSP.

• Establish and adjust reserves in a timely and appropriate manner.

• Identify and seek out opportunities for subrogation and recovery.

• Ensure compliance with state regulatory mandates and prompt distribution of necessary communications and forms.

• Manage low-complexity litigated cases and coordinate assignments of defense counsel.

• Oversee and assess vendors, invoices, and associated expenses.

• Draft coverage decisions, reservation of rights letters, and denial notices.

• Provide updates on case status and escalate issues as necessary.

• Assess liability and damages, develop negotiation strategies, resolve liens, and negotiate settlements.

• Complete settlements, which includes documentation, releases, payments, mediations, and arbitrations.

• Collaborate with Special Investigations Unit (SIU), Subrogation, Legal, Underwriting, and Risk departments.

• Contribute to team support, training initiatives, and various projects.

⛳️ Requirements

• Bachelor’s degree or equivalent relevant experience is required.

• A minimum of three years of experience in casualty claims adjusting or a related field is necessary.

• Relevant insurance designations are preferred.

• Extensive knowledge of the theory and practice associated with claims functions.

• Strong understanding of insurance contracts, medical terminology, and relevant substantive and procedural laws.

• Proficient in computer systems and claims management software.

• Ability to obtain all necessary state licenses.

• Commitment to maintaining high standards of professional conduct and ethical practices.

• Excellent organizational abilities and empathetic interpersonal skills.

• Strong written and verbal communication capabilities.

• Exceptional investigative and problem-solving skills.

• Outstanding customer service abilities.

• Capacity to maintain confidentiality at all times.

• Occasional travel may be required.

• A valid driver's license with an acceptable motor vehicle record is required for travel in accordance with company standards.

🏝️ Benefits

• Comprehensive rewards package; details on benefits available at www.emcins.com/careers.

• Opportunity to work from home.

• Tobacco-free work environments and company vehicles.