Claims Specialist
EMC Insurance
Job Description
<p><b>At EMC, we’re all about working together to make an impact. As part of our team, you’ll have the opportunity to grow, contribute, and gain experience that matters. We strive to be caring leaders, close partners, and responsive experts—always supporting each other to do our best work. Join us, and let’s improve lives together.</b></p><h3><b>Essential Functions</b></h3><br><ul>
<li>Investigates and manages complex, multi-line and multi-state claims, including general liability and workers’ compensation losses.</li>
<li>Reviews coverage, investigates facts of loss, obtains statements, evaluates medical and loss information, and develops effective claim resolution strategies.</li>
<li>Establishes appropriate reserves and maintains accurate, timely claim documentation in accordance with client handling requirements.</li>
<li>Evaluates coverage, liability, compensability, damages, and settlement exposure and communicates claim decisions to appropriate parties.</li>
<li>Identifies and pursues subrogation opportunities and coordinates referrals to specialized resources, including Special Investigation, Medical Review, and other appropriate teams.</li>
<li>Negotiates and resolves complex claims within assigned authority, including preparing claim evaluations, settlement ranges, denial correspondence, and settlement documentation.</li>
<li>Partners with defense counsel on litigated claims and provides clients with guidance regarding litigation and resolution strategies.</li>
<li>Maintains compliance with applicable state reporting, Medicare, excess carrier, and other claim-related requirements.</li>
<li>Builds strong client relationships through responsive communication, consultation, file reviews, claim summaries, and coordination of appropriate resources.</li>
<li>Analyzes claim and settlement trends to identify opportunities and support client needs.</li>
<li>Maintains required professional licenses and continuing education while staying current on jurisdictional and industry developments.</li>
<li>Serves as a technical resource to Claims team members, providing guidance on coverage, compensability, investigations, and claim strategy.</li>
<li>This role covers Iowa, Arizona, Utah, and Texas</li>
</ul><br><h3>EDUCATION & EXPERIENCE</h3><ul>
<li>Bachelor’s degree or equivalent relevant experience</li>
<li>Seven years of claims adjusting experience or related experience</li>
<li>Must have adjusters experience in Iowa, Arizona, and Utah</li>
<li>Adjusters experience in Texas is preferred</li>
<li>Prior experience with a third party administrator (TPA) preferred</li>
<li>INS, AIC, SCLA, WCLA and CPCU designation preferred</li>
</ul><h3>KNOWLEDGE, SKILLS & ABILITIES</h3><ul>
<li>Advanced knowledge of best claims practices used to resolve the serious and complex injury and worker’s compensation, general liability, property and auto commercial claims</li>
<li>Excellent knowledge of the claim function</li>
<li>Advanced analytical, investigative, an