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Claim Adjuster II Auto/Casualty job in Oakbrook Terrace at EMC Insurance

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Claim Adjuster II Auto/Casualty at EMC Insurance

Claim Adjuster II Auto/Casualty

EMC Insurance Oakbrook Terrace, IL (On Site) Full-Time

At EMC, you'll put your skills to good use as an important member of our team. You can count on gaining valuable experience while contributing to the company's success. EMC strives to hire and retain the best people by engaging, developing and rewarding employees.

This position can be performed remotely for candidates who reside in IL, MN, WI, IA, MS, LA, MO, or AR.

Essential Functions:

  • Promptly investigates and evaluates claims:
  • Reviews the claim notice and policy to verify coverage, deductibles, claim payee/mortgagees and compensability
  • Initiates contact with customers to obtain information on the claim and explain the claim process
  • Takes statements from insureds/claimants/witnesses and documents summaries within the claims system
  • Documents handling activity including Medicare (MSP) modules in the claims system
  • Sets timely, adequate reserves in compliance with the company reserving philosophy and methodology
  • Resolves questions of coverage, liability and the value of claims
  • Drafts reservation of rights and denial letters when appropriate
  • Handles litigated files of lower complexity
  • Obtains authority from Supervisor/Manager in the assignment of defense counsel for litigated claims
  • Assigns independent adjusters when necessary with supervisory approval
  • Secures all necessary official reports, claim forms and documents
  • Reviews bills, invoices and receipts for accuracy
  • Reviews legal invoices and litigation related expenses for accuracy and appropriateness
  • Provides prompt, detailed responses to agents, insureds and claimants on the status of claims
  • Identifies, investigates, and proactively pursues opportunities for recovery
  • Negotiates, settles and/or resolves claims:
  • Prepares bodily injury and/or damage evaluations, analyzes negotiation ranges and target settlement numbers prior to negotiation
  • Communicates with insureds/claimants/attorneys to negotiate the settlement of claims
  • Assists in suits, mediations, and arbitrations
  • Issues settlement documents and verifies that they are properly executed
  • Issues timely payments within check authority limit
  • Investigates Medicare liens and timely resolve in accordance with EMC and Medicare guidelines
  • Collaborates with other departments:
  • Submits referrals to the Estimatics Review, Special Investigation, Property Review, Subrogation and Medical Review Units, when necessary
  • Prepares risk reports for Underwriting
  • Reviews coverage intent and policy activity with Underwriting
  • Reviews account inspection information with Risk Improvement
  • Assists own branch claims team members as needed. Assists other branches in handling of claims (due to storms or temporary staffing gaps) through Resource Sharing Program. Participates in branch and department projects.
Education & Experience:
  • Bachelor's degree or equivalent relevant experience
  • Three years of claims adjusting experience
  • Attainment of all applicable state licenses within six months of hire
  • Relevant insurance designations preferred
Knowledge, Skills & Abilities:
  • Strong knowledge of the theory and practice of the claim function
  • Good knowledge of insurance contracts, medical terminology and substantive and procedural laws
  • Ability to adhere to high standards of professional conduct and code of ethics
  • Strong knowledge of computers and claims systems
  • Strong written and verbal communication skills
  • Excellent customer service skills
  • Solid investigative and problem-solving abilities
  • Strong organizational abilities and empathetic interpersonal skills
  • Travel required; a valid driver's license with an acceptable motor vehicle report per company standards required if traveling

First Shift (United States of America)

Our employment practices are in accord with the laws which 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.

To learn more about why you're gonna love it here, watch the video below.

Recommended Skills

  • Claim Processing
  • Communication
  • Coordinating
  • Customer Service
  • Ethics
  • Insurance Management And Aftercare
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