EMC Insurance Companies · 10 hours ago
Casualty Claims Adjuster I
United States
Full-time
Remote
Entry Level
$56K/yr - $85K/yr
1+ years expEMC Insurance Companies is committed to making an impact through teamwork and support. They are seeking a Casualty Claims Adjuster I who will be responsible for reviewing claims, investigating coverage, and communicating with insureds and claimants to resolve claims in a timely manner.
FinanceProperty & Casualty InsuranceFinancial ServicesInsurance
Responsibilities
Reviews the claim notice, contracts, state statutes and policies to verify the appropriate coverage, deductibles, and payees
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
Request and analyze 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 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
Reviews bills, invoices and receipts for accuracy and appropriateness
Notifies 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
Makes recommendations to people leader on the assignment of independent adjusters
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 authority when required
Identifies and protects all liens as appropriate
Investigates Medicare liens and resolves issues 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
Issues timely payments
Reviews and audits estimates written by independent adjusters 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 teams as appropriate
Prepares risk reports for Underwriting and Risk Improvement
Prepares claims and participates in claims roundtables to discuss unique cases to evaluate coverage and damage
Qualification
Required
Bachelor's degree or equivalent relevant experience
One year of casualty claims adjusting experience or related experience
Good knowledge of the theory and practice of the claim function
Good 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
Good 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 traveling
Preferred
Relevant insurance designations preferred
Company
EMC Insurance Companies
EMC Insurance is a top insurer based on net written premium, and we have more than 2,200 employees.
1001-5000 employees
Funding
Current Stage
Public CompanyTotal Funding
unknown1982-02-12IPO
Leadership Team
Matthew Spackman
SVP-Chief Human Resources Officer
P
Philip Lucca
Retired
Recent News
Corridor Business Journal
2025-06-28
2024-04-11
Company data provided by crunchbase