Claim Processor

Church Mutual Insurance Company, S.I.•Merrill, WI

About The Position

In accordance with the application of state and federal laws and company best practices, this role provides claimants and insureds with clear and correct instructions regarding the claim process. The Claim Processor processes basic claims by verifying coverage, obtaining and documenting necessary information for the claim, and issuing appropriate payments as directed. On any given day, this role will process newly reported claims, initiate basic claim investigation, and redirect moderate and complex claims to a higher level Claim Representative as required. This role also performs Claim Processing System entry and maintenance, including file setup, coverage verification, applicable coding, establishing reserves, and issuing payments. The Claim Processor verifies coverage and determines the company's obligation(s) to the insured and/or claimant. They review claims to determine the type of claim presented, claim documentation/evidence presented, amount of claim, or amount due. This role establishes and monitors case reserves for adequacy during the life of the claim. They review loss for subrogation potential and refer to the Subrogation Specialist, if appropriate. The Claim Processor provides additional instruction to the insured or requests additional information. They submit necessary state filings and create and send appropriate required state notices and letters. The role completes the claim process by obtaining and reviewing support documentation in accordance with existing state laws and fee schedules and makes appropriate payments. Finally, the Claim Processor assists other claim handlers as requested.

Requirements

Two years of insurance processing and/or equivalent customer service work experience.
Ability to obtain and maintain state adjusting license requirements and complete continuing education requirements.
Ability to deal effectively and provide positive customer service with insureds and claimants by phone, email, and in writing.
Proficient keyboarding skills.
Able and willing to follow instructions.
Possess a positive attitude.
Ability to handle rush or unexpected assignments.
Ability to acquire knowledge of insurance terminology.

Nice To Haves

Prior claim processing experience is preferred.
Associate degree in insurance or business preferred.
Additional courses in insurance and/or medical terminology desirable.

Responsibilities

Process newly reported claims, initiate basic claim investigation, and redirect moderate and complex claims to a higher level Claim Representative as required.
Perform Claim Processing System entry and maintenance, including file setup, coverage verification, applicable coding, establishing reserves, and issuing payments.
Verify coverage and determine our obligation(s) to the insured and/or claimant.
Review claims to determine type of claim presented, claim documentation/evidence presented, amount of claim, or amount due.
Establish and monitor case reserves for adequacy during the life of the claim.
Review loss for subrogation potential and refer to the Subrogation Specialist, if appropriate.
Provide additional instruction to insured or request additional information.
Submit necessary state filings and create and send appropriate required state notices and letters.
Complete the claim process by obtaining and reviewing support documentation in accordance with existing state laws and fee schedules and make appropriate payments.
Assist other claim handlers as requested.