Technical Claim Specialist-TCS

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

8d•Hybrid

About The Position

Responsible for handling large, complex claim files, including litigated matters, catastrophic claims, in accordance with applicable state and federal laws. Set reserves and settle claims within level of authority. Direct work of defense attorney. Actively share knowledge with team members, contribute to training programs, and mentor other claim representatives.

Requirements

Eight or more years in technical insurance claim roles with increasing responsibilities is required.
Bachelor's degree preferred. A combination of equivalent education and/or experience may be considered in lieu of a degree.
Evidence of continuing education in the insurance industry is required.
Ability to obtain and maintain state adjusting license requirements and complete continuing education requirements.
Advanced knowledge of recoveries such as subrogation, reinsurance, apportionment, and deductibles.
Advanced knowledge of WC claim handling, second injury funds, etc. Knowledge or willingness to learn multiple jurisdictions.
Advanced negotiation skills.
Strong listening, verbal, and written communication skills.
Advanced knowledge of policy terminology, legal principles involving insurance, and emerging industry trends.
Effective planning and organization skills.
Ability to mentor and coach other adjusters on the team as needed.

Nice To Haves

Completion of AIC and/or CPCU is preferred.

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.
Make complex coverage and compensability 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 applicable statutory language.
Perform a thorough good faith investigation. Inspect loss sites as necessary. Upon completion of the investigation, analyze and evaluate the compensability of the claim and related exposure. Formulate and document an action plan and ensure timely and appropriate administrate of benefits as set forth by jurisdictional regulations.
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.
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.
Provide knowledge and guidance to other claim handlers regarding claim strategy, compensability decisions, and in-depth jurisdictional and legal nuances. Field questions from team members related to coverage/compensability decisions.
Investigate and refer identified claims to Loss Recovery Services, as applicable.
Direct work of defense attorney through collaboration on claim strategy and resolution. Ensure defense attorney is adhering to Litigation Management guidelines. Manage claim expense by concluding vendor assignment when vendor is no longer adding value to the claim.
Present complex claim files during roundtables and claims committee meetings completing necessary large loss notifications.