Church Mutual Insurance Company, S.I.

Claim Representative III - Workers Compensation

Job Locations US
ID
20243515
Category
Claim
Type
Regular Full-Time

Introduction

Looking to join a vibrant organization that makes a difference?

At Church Mutual, our customers are at the heart of everything we do. For more than 125 years, we’ve made it our business to protect those who serve and inspire others through our specialized insurance expertise and innovative solutions. Our customers do amazing things for the world — when we protect them, we Stand for Good. We foster a workplace where all employees are treated with dignity and respect; diversity, inclusion and belonging are woven into the fabric of our company through our customers, employees, leadership, business relationships and outreach programs.

What you’ll be doing:

In accordance with application of state and federal laws and company best practices, handle higher exposure, complex claims within an assigned line of coverage. Gather and review claim information, determine coverage, and conduct investigation. Initiate and maintain customer contact to provide updates and resolve any issues with the claim. Update information in the claim system to document claim handling activities. Determine/set reserves and make payments within level of authority. Investigate and refer identified claims to Loss Recovery Services, as applicable.

On any given day, you’ll:

I. 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.

 

II. 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.

 

III. Perform a thorough investigation based upon the type, complexity, and severity of the claim. Upon completion of the investigation, analyze and evaluate the potential exposure and damages, including potential full or partial liability and compensability denials. Formulate and document an action plan based on the covered damages and injuries.

 

IV. 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. Refer claims above authority to appropriate team member for review and potential reassignment.

 

V. 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.

 

VI. Recognize when vendor partners are required on a claim, including experts, independent adjustors, nurses, defense attorneys, etc. 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.

 

VII. Investigate and refer identified claims to Loss Recovery Services, as applicable.

 

VIII. Act as a resource to share knowledge and experience with other claim handlers. Assist and support their development with mentoring and auditing functions.

 

IX. Attend mediations as requested.

Here’s what we expect

1. Prior Experience:

Five to seven years of claim handling and/or other insurance-related experience is required.

 

2. Education:

• Bachelor’s degree preferred. A combination of equivalent education and/or experience may be considered in lieu of a degree.
• Additional training in insurance, medical, and/or building terminology knowledge is desirable.
• Completion of INS, AIC, or CPCU is preferred.

 

3. Necessary Knowledge and Abilities:

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

 

Church Mutual is an equal opportunity employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, veteran or disability status.

 

Exact compensation will vary based on consideration of a variety of factors including education, skills, experience, and location.

Minimum Compensation

USD $69,000.00/Yr.

Maximum Compensation

USD $103,500.00/Yr.

Options

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Learn about our benefits: We value your hard work, dedication to our customers, and contributions to the team — and we understand the importance of benefits for today and planning for the future. Our generous, flexible total rewards provide you and your family with security and peace of mind. View our full total rewards package here


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