[Hiring] Claim Representative III - GL/Commercial Auto @Church Mutual Insurance Company, S.I.

Role Description

In accordance with application of state and federal laws and company best practices, gather and review claim information, determine coverage, determine duty, and conduct liability investigations. Initiate and maintain contact with claim parties to provide updates and resolve issues timely. Update the claim system to document claim handling activities throughout the life of the claim. Determine, set, and maintain reserves and issue payments in line with a level of authority. Review contracts and thoroughly investigate risk transfer possibilities. Investigate and refer identified claims to Loss Recovery Services, as applicable. Direct vendors and review reports to evaluate exposure. Manage and direct counsel when litigation is involved.

On any given day, you'll:

• Perform claim tasks timely and document claim files appropriately.
• Proactively manage claim activities to ensure fair claim resolution.
• Handle all claims in accordance with state and federal laws.
• Make complex coverage decisions by gathering information necessary to make an informed decision in a fair, equitable, and ethical manner.
• Deny losses within authority level, providing detailed explanation, citing facts, and policy language.
• Perform a thorough investigation based upon the type, complexity, and severity of the claim.
• Upon completion of the investigation, analyze and evaluate the potential exposure and damages, including potential full or partial liability and compensability denials.
• Formulate and document an action plan based on the covered damages and injuries.
• Determine and set reserves based on the most probable outcome of the claim, within authority level.
• Evaluate and negotiate directly with insured, claimant, or claimant's attorney on all cases within authority level.
• Review claim facts and exposure with claims management, as appropriate, to guide claim strategy.
• Make complete, accurate, and timely payments within authority for covered losses.
• Refer claims above authority to appropriate team member for review and potential reassignment.
• Maintain a professional, courteous, and helpful approach when communicating in-person, on the phone, or through email and other correspondence with internal and external customers, business partners and brokers.
• Recognize when vendor partners are required on a claim, including experts, independent adjustors, nurses, defense attorneys, etc.
• Assign and direct vendors, as needed, to aid in the investigation and evaluation of the claim.
• Manage claim expense by concluding vendor assignment when vendor is no longer adding value to the claim.
• Investigate and refer identified claims to Loss Recovery Services, as applicable.
• Act as a resource to share knowledge and experience with other claim handlers.
• Assist and support their development with mentoring and auditing functions.
• Negotiate settlements, attend mediations, attend settlement conferences, engage in various ADR opportunities.

Qualifications

• Minimum of seven years claim handling experience is required.
• Three years of litigation management experience is preferred.
• Bachelor's degree preferred. A combination of equivalent education and/or experience may be considered in lieu of a degree.
• Additional training in insurance, medical, and/or building terminology knowledge is desirable.
• Completion of INS, AIC, or CPCU is preferred.

Requirements

• Ability to obtain and maintain state adjusting license requirements and complete continuing education requirements.
• Ability to work independently and manage workload timely.
• Strong listening, verbal, and written communication skills.
• Proficient knowledge of policy terminology and legal principles involving at least one or more of the following: insurance, automobile, medical and property claims.

Company Description

Church Mutual is an equal opportunity employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, veteran or disability status. Exact compensation will vary based on consideration of a variety of factors including education, skills, experience, and location.