Claims Specialist

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.
Essential Functions

Investigates and manages complex, multi-line and multi-state claims, including general liability and workers’ compensation losses.

Reviews coverage, investigates facts of loss, obtains statements, evaluates medical and loss information, and develops effective claim resolution strategies.

Establishes appropriate reserves and maintains accurate, timely claim documentation in accordance with client handling requirements.

Evaluates coverage, liability, compensability, damages, and settlement exposure and communicates claim decisions to appropriate parties.

Identifies and pursues subrogation opportunities and coordinates referrals to specialized resources, including Special Investigation, Medical Review, and other appropriate teams.

Negotiates and resolves complex claims within assigned authority, including preparing claim evaluations, settlement ranges, denial correspondence, and settlement documentation.

Partners with defense counsel on litigated claims and provides clients with guidance regarding litigation and resolution strategies.

Maintains compliance with applicable state reporting, Medicare, excess carrier, and other claim-related requirements.

Builds strong client relationships through responsive communication, consultation, file reviews, claim summaries, and coordination of appropriate resources.

Analyzes claim and settlement trends to identify opportunities and support client needs.

Maintains required professional licenses and continuing education while staying current on jurisdictional and industry developments.

Serves as a technical resource to Claims team members, providing guidance on coverage, compensability, investigations, and claim strategy.

This role covers Iowa, Arizona, Utah, and Texas

EDUCATION & EXPERIENCE

Bachelor’s degree or equivalent relevant experience

Seven years of claims adjusting experience or related experience

Must have adjusters experience in Iowa, Arizona, and Utah

Adjusters experience in Texas is preferred

Prior experience with a third party administrator (TPA) preferred

INS, AIC, SCLA, WCLA and CPCU designation preferred

KNOWLEDGE, SKILLS & ABILITIES

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

Excellent knowledge of the claim function

Advanced analytical, investigative, and problem-solving abilities with liability and coverage

Excellent knowledge of insurance contracts, medical terminology and legal aspects of court procedures affecting legal liability for all lines of insurance

Advanced computer skills, including claims systems

Exceptional organizational, written and verbal communication skills, including documentation

Thorough investigative and problem-solving abilities

Excellent ability to advise, partner, and effectively consult with diverse internal and external stakeholders

Occasional travel required

The hiring salary range for this position will vary based on geographic location, falling within either of the following:
$85,799 - $118,545 or $94,826 - $130,394A hiring range represents a subset of the full salary range. The actual salary will depend on several factors, including relevant education, skills, and experience of an applicant, geographic location, and business needs.
For information relating to the benefits EMC Team Members receive as part of a comprehensive rewards package, please visit www.emcins.com/careers.
Our employment practices are in accordance with the laws that prohibit discrimination due to race, color, creed, sex, sexual orientation, gender identity, genetic information, religion, age, national origin or ancestry, physical or mental disability, medical condition, veteran status, active military status, citizenship status, marital status or any other consideration made unlawful by federal, state, or local laws.
All of our locations are tobacco free including in company vehicles.
Originally posted on Himalayas