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Church Mutual Insurance Company, S.I. · 1 day ago

Technical Claim Specialist, Casualty - Fully Remote

United States

Full-time

Remote

Senior Level, Lead/Staff

8+ years exp

Church Mutual Insurance Company, S.I. is a provider of insurance solutions, and they are seeking a Technical Claim Specialist to manage complex casualty claims. The role involves handling large claims, making coverage decisions, and providing mentorship to team members while ensuring compliance with legal standards.

AssociationGovernmentNon Profit

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 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. Inspect loss sites as necessary. Upon completion of the investigation, analyze and evaluate the potential high exposure and extensive 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

Maintain a professional, courteous, and helpful approach when communicating in person, on the phone, 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, coverage interpretations, 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

Engage in direct investigation, control, and settlement negotiations when outside adjusting and legal services are not necessary or available

Attend mediations, depositions, and trials. Present complex claim files during roundtables and claims committee meetings

Qualification

General Liability experienceProfessional Liability experienceAdvanced negotiation skillsAIC certificationCPCU certificationTechnical insurance claim experiencePlanningCommunication skillsOrganization skills