Claim Representative I

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 handles low to moderate value claims within an assigned line of coverage, such as medical payments, short duration indemnity, minor auto physical damage, property damage, business personal property, and low exposure bodily injury claims. The position involves gathering and reviewing claim information, determining coverage, and conducting investigations. It requires initiating and maintaining customer contact to provide updates and resolve claim issues, updating the claim system to document handling activities, and determining/setting reserves and making payments within the level of authority. The role also includes investigating and referring identified claims to Loss Recovery Services, as applicable.

Requirements

Ability to obtain and maintain state adjusting license requirements and complete continuing education requirements.
Evidence of organizational skills, ability to prioritize and to think independently.
Strong listening, verbal and written communication skills.
Basic knowledge of policy terminology and legal principles involving at least one or more of the following: commercial insurance, automobile, medical and property claims.

Nice To Haves

Bachelor's degree preferred.
A combination of equivalent education and/or commercial insurance experience may be considered in lieu of a degree.
Additional training in commercial insurance, medical, and/or building terminology knowledge is desirable.
Prior insurance experience is beneficial.

Responsibilities

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.
Verify coverage at a foundational level by gathering adequate information necessary to make an informed decision in a fair, equitable, and ethical manner.
Evaluate subrogation potential based on the applicability of policy language and/or governing state laws and statutes as appropriate.
With supervision, perform a thorough investigation and obtain pertinent file documentation (i.e., police report, medical records, estimates, photos, etc.).
Analyze and evaluate potential exposure and damages, including potential full or partial liability, compensability denials and subrogation potential as applicable.
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.
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 and business partners.
Recognize when vendor partners are required on a claim.
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.
Completes all other assigned duties, as requested.