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

Senior Technical Claim Specialist

United States

Full-time

Remote

Senior Level, Lead/Staff

15+ years exp

Church Mutual Insurance Company, S.I. is seeking a Senior Technical Claim Specialist to handle large, complex claim files. The role involves managing claims in accordance with applicable laws, directing defense attorneys, and mentoring team members while staying informed on litigation trends.

AssociationGovernmentNon Profit

Responsibilities

Responsible for handling large, complex claim files, including litigated matters, catastrophic claims, umbrella claims, punitive damage claims, severe injury, long duration indemnity, permanent total disability, structural building damage, multiple location damage, including business income exposure and other extensive exposure 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

Stay abreast of current and emerging complex litigation claim settlement issues, trends, court decisions, plaintiff bar activities, and partner with key CM Group stakeholders to share information and analyze potential impacts on our products and chosen markets

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

Caseload will consist largely of the most complex, high exposure matters involving issues such as policy limits, excess coverage, layered coverages, total loss matters, permanent total disability claims, catastrophic injury, and other specialty type, unique claims

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

Stay abreast of current and emerging complex litigation/claim settlement issues, trends, court decisions, and plaintiff bar activities

Actively communicate and share knowledge of trends, litigation environment, and potential impacts with key CM Group stakeholders

Qualification

AIC designationCPCU designationAdvanced knowledge of policy terminologyAdvanced negotiation skillsLegal educationAdvanced knowledge of recoveriesAdvanced knowledge of reinsurance contractsFifteen years insurance experienceEffective planning skillsListening skillsCommunication skills