Workers Compensation Claim Representative II

Church Mutual Insurance Company, S.I.•,

7h•Remote

About The Position

The Workers Compensation Claim Representative II handles moderate-value claims within an assigned line of coverage in accordance with applicable state and federal laws and company best practices. Claim types may include medical-only claims, short- to moderate-duration indemnity, automobile physical damage, property damage, business personal property, non-structural building damage, low- to moderate-severity bodily injury, and subrogation. The representative gathers and reviews claim information, determines coverage, conducts investigations, communicates with customers, documents claim activities, sets reserves, and makes payments within their authority. The role also identifies claims for referral to Loss Recovery Services. The representative proactively manages claim activities to support fair resolution and compliance with jurisdictional requirements. With limited supervision, they investigate claims according to their type, complexity, and severity; assess exposure and damages; develop documented action plans; and negotiate with insureds, claimants, or attorneys within their authority. They may coordinate vendors, review claim strategy with management, refer claims exceeding their authority, and provide developmental support to Claim Representative I. Other assigned duties may also be required.

Requirements

Ability to obtain and maintain state adjusting license requirements and complete continuing education requirements.
Evidence of organizational skills, ability to prioritize, and ability to think independently.
Strong listening, verbal, and written communication skills.
Knowledge of policy terminology and legal principles involving one or more of commercial insurance, automobile, medical, and property claims.
A bachelor's degree is preferred; equivalent education and/or commercial insurance experience may be considered in lieu of a degree.

Nice To Haves

Additional training in commercial insurance, medical, and/or building terminology.
Completion of courses toward one or more of the INS or AIC designations.
A minimum of two years of commercial insurance and/or claims handling experience is ideal.
A bachelor's degree.

Responsibilities

Handle moderate-value claims in an assigned line of coverage in accordance with state and federal laws and company best practices.
Complete claim tasks promptly and document claim files appropriately.
Proactively manage claims to support fair resolution and comply with jurisdictional requirements.
Gather information to verify coverage and make informed, fair, equitable, and ethical decisions.
Evaluate subrogation potential based on policy language and applicable laws and statutes.
Conduct thorough investigations based on claim type, complexity, and severity.
Analyze and evaluate potential exposure and damages, including possible full or partial liability and compensability denials.
Formulate and document action plans based on covered damages and injuries.
Set reserves based on the most probable claim outcome and within the representative's authority.
Evaluate and negotiate with insureds, claimants, or claimant's attorneys on cases within authority.
Review claim facts and exposure with claims management, as appropriate, to guide claim strategy.
Make complete, accurate, and timely payments for covered losses within authority.
Refer claims exceeding authority to an appropriate team member for review and potential reassignment.
Communicate professionally and courteously with internal and external customers and business partners in person, by phone, email, and other correspondence.
Identify when vendor partners are needed, assign and direct them, and conclude assignments when they no longer add value to the claim.
Investigate and refer identified claims to Loss Recovery Services, as applicable.
May act as a resource to Claim Representative I to support their development.
Complete other assigned duties as requested.