EMC Insurance

Senior Complex Claims Specialist

EMC Insurance$103K — $164K *
US-AnywhereRemote in United States
Finance & Insurance
8 - 10 years of experience
Job Overview by Ladders

Qualifications

  • Bachelor's degree in business, economics, or related field, or equivalent experience
  • 10 years in complex claims handling or litigation, including at least 3 years of claims litigation experience
  • Preferred insurance designations such as AIC, CPCU
  • Exceptional knowledge of litigation management and technical file handling
  • Strong understanding of insurance contracts, medical terminology, and legal aspects of court procedures

Responsibilities

  • Directly handle complex casualty and litigated claims nationwide
  • Proactively manage claims to ensure timely resolution and expense management
  • Serve as a subject matter expert on complex coverage issues
  • Conduct thorough investigations into coverage, liability, and damages
  • Prepare claim evaluations and develop negotiation plans
  • Collaborate with defense counsel on strategic defense and resolution
  • Promote improved claims handling practices through training and support

Benefits

  • Opportunity to work from home anywhere in the US
  • Comprehensive rewards package and benefits
  • Engagement in special projects to enhance claims handling expertise
Full Job Description

**This position is eligible to work from home anywhere in the US**

Directly handles the company's most complex casualty claims and litigated claims on a nationwide basis. Models best claims handling practices with an emphasis on the strategic handling and resolution of these complex claims. Delivers timely, expert support to the regional casualty claims teams on technical claims handling, negotiation strategy, coverage, liability, damages, and reserves.

Essential Functions:

Directly handles the company's most complex claims and litigated claims involving serious injuries and highly sensitive/high profile cases

  • Proactively handles assigned claims to conclusion while modeling best claims handling practices, managing expenses, and pursuing early resolution when appropriate to positively impact indemnity outcomes

  • Serves as the subject matter expert on highly complex coverage issues impacting assigned claims, seeks assistance when needed or appropriate, issues coverage correspondence, and takes coverage into account when setting reserves and driving claims towards resolution

  • Sets timely, accurate, and well-documented reserves with proper communication to the agent, Branch VPs, and claims leadership while taking exposure, liability, allocation, and coverage into account

  • Conducts timely, thorough investigations into coverage, liability and damages while identifying, utilizing, and managing appropriate vendors based on need, expertise, expense, and geographic considerations

  • Prepares timely, concise, claim evaluations and file reviews

  • Develops, documents, and executes negotiation plans

  • Maintains timely and appropriate diary on all claims for optimum case control, exposure evaluation, expense management, and progress towards resolution

  • Composes concise claim notes, attaching documents when appropriate and using proper claim note categories and document titles

  • Collaborates with defense counsel to develop strategic defense and resolution strategies with action plans, appropriate budgets and invoice reviews.

  • Presents claims in Claim Committee and Complex Roundtables and facilitates claim file discussions, and engages in Committee discussion to share technical claim handling and resolution expertise

  • Attends all mediations and trials, as necessary

Provides expert guidance to General Casualty, Complex, and/or Specialty Teams, including on serious injury claims

  • Reviews and communicates comprehensive evaluations of assigned claims presenting serious injuries (such as fatality, amputation, loss of sight, burns, paraplegia, quadriplegia, sex abuse, etc.), intellectual property claims, and claims with exposures of $750,000 or greater

  • Provides timely communication and assistance to various claims adjusters, managers, directors and/or claims leadership on issues requiring special attention

  • Provides follow up reviews when appropriate

  • Contributes to ongoing regional needs assessment analysis with insights gathered during Casualty collaboration process

Promotes and supports improved technical claims handling across claims teams in accordance with Best Practices

  • Identifies, recommends, develops, and delivers new training programs based on identified needs, opportunities, and industry trends, in collaboration with Learning and Development and claims leadership

  • Prepares engaging presentation materials and provides significant contributions as a leader and/or facilitating member during trainings

  • Identifies regional claims team members as potential candidates for the Complex Casualty Claims team

  • Actively participates in special projects to build company claims handling expertise and promote improved claim outcomes

Delivers exceptional customer service to General Casualty, Complex and/or Specialty Teams, insureds, agents, and internal customers

  • Delivers timely, expert support to the Casualty claims teams on technical claims handling, negotiation strategy, coverage, liability, damages, and reserves

  • Provides insureds and agents with concise, accurate status of claim activity and explanations of coverage, claim value and settlements

  • Promptly and appropriately responds to regional claim teams, insureds, agents, and internal customers

  • Serves as a technical subject matter consultant for regional team members and makes recommendations to Claims Consultant, Manager and/or Director for technical claims handling growth

Education & Experience:

  • Bachelor’s degree, preferably in business, economics, or related field, or equivalent related experience

  • Ten years of experience in complex claims handling or claims litigation, or relevant experience, including at least three years of claims litigation experience

  • Insurance designations such as AIC, CPCU, and/or other insurance education preferred

Knowledge, Skills & Abilities:

  • Exceptional knowledge of litigation management, coverage, and technical file handling

  • Strong knowledge of the theory and practice of the claims function

  • Strong ability to evaluate legal liability, damages, coverages, and exposure

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

  • Excellent leadership, collaboration, and negotiation skills

  • Excellent knowledge of computers and claims systems

  • Strong organizational, written and verbal communication skills

  • Excellent customer service skills

  • Advanced investigative and problem-solving abilities

  • Travel required (20%); a valid driver’s license with an acceptable motor vehicle report per company standards required if driving

The hiring salary range for this position will vary based on geographic location, falling within either of the following:

$103,954 - $149,372 or $114,895 - $164,309

A 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.

About EMC Insurance

EMC Insurance Group Inc. is an insurance holding company based in Des Moines, Iowa. The company provides property and casualty insurance products and services to businesses and individuals in the United States. The company operates through two segments: Property and Casualty Insurance and Reinsurance. The Property and Casualty Insurance segment provides commercial and personal lines of insurance products. The Reinsurance segment provides reinsurance for other insurers. The company was founded in 1911 and is publicly traded on the NASDAQ under the ticker symbol EMCI.
Learn more about EMC Insurance
Industry
Founded
1911
NASDAQ

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