Senior Casualty Claims Adjuster

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

📋 Description

• Review claim notifications, lawsuits, contracts, and policies to confirm coverage, deductibles, claim payees/mortgagees, and compensability.

• Communicate with customers, insureds, claimants, and witnesses to gather claim information and clarify the claims process.

• Document statements and summaries, as well as manage activities in the claims system, including Medicare/MSP modules.

• Establish timely and adequate reserves in line with the company's reserving philosophy and methodology.

• Select suitable defense counsel for litigated claims and manage medium- to lower-complexity lawsuits.

• Address coverage, liability, and claim-value inquiries; draft reservation-of-rights and denial letters when necessary.

• Assign independent adjusters as needed with supervisory approval.

• Obtain official reports, claim forms, and other essential documents.

• Assess bills, invoices, receipts, legal invoices, and litigation expenses for correctness and relevance.

• Respond to agents, insureds, and claimants regarding the status of claims.

• Investigate and seek recovery opportunities; explore and resolve Medicare liens.

• Prepare evaluations for bodily injury and/or property damage, including negotiation ranges and target settlement figures.

• Negotiate claim settlements with insureds, claimants, and attorneys.

• Provide assistance during lawsuits, mediations, arbitrations, and depositions.

• Engage in claims roundtables and ensure the issuance of properly executed settlement documents and timely payments.

• Submit referrals to specialist review units when needed.

• Compile risk reports for Underwriting and review coverage intent, policy activity, and account inspection details with relevant teams.

• Mentor and guide less experienced claims team members; support other branches through the Resource Sharing Program.

• Participate in branch and departmental projects.

⛳️ Requirements

• Bachelor’s degree or equivalent relevant experience.

• Five years of experience in claims adjusting.

• Must obtain all applicable state licenses within six months of hire.

• Relevant insurance designations are preferred.

• Demonstrated excellent understanding of the theory and practice of the claims function.

• Strong analytical skills and sound judgment regarding liability and coverage.

• In-depth knowledge of insurance contracts, medical terminology, and legal aspects of court procedures.

• High standards of professional conduct.

• Proficient in computers and claims systems.

• Strong organizational skills along with written and verbal communication abilities.

• Exceptional investigative and problem-solving skills.

• Travel may be required; a valid driver’s license with an acceptable motor vehicle report per company standards is necessary when traveling.

🏝️ Benefits

• Comprehensive rewards package; benefits information is available at www.emcins.com/careers.

• Opportunity to work from home anywhere in the United States.

• Tobacco-free workplaces and company vehicles.