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Claim Representative III-Excess & Surplus - Madison

Company: Church Mutual
Location: Madison
Posted on: October 12, 2019

Job Description:

Tracking Code1693Job DescriptionIn accordance with application of state and federal laws and company best practices, handle moderate value claims with higher exposure, within Excess & Surplus lines such as property damage, business personal property, business income loss 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. This role will be based in our Madison, WI office.Duties and Responsibilities

  • --Perform claim tasks timely and document claim files appropriately. Proactively manage claim activities to ensure fair claim resolution with limited supervision. 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. 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.
  • 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.
  • 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.
  • 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.
  • Investigate and refer identified claims to Loss Recovery Services, as applicable.
  • Act as a resource to share knowledge and experience with other claim handlers. Assist and support their development with mentoring and auditing functions.
  • Attend mediations as requested. Essential Functions
    • 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 and deny claims within authority levels.
    • Perform a thorough investigation based upon the type, complexity, and severity of the claim.
    • Complete, analyze, and evaluate the potential exposure and damages and formulate an action plan.
    • Determine and set reserves and make complete, accurate, and timely payments for covered losses within authority level.
    • Meet the needs of internal and external customers, business partners, and brokers in a professional and appropriate manner.
    • Assign and direct vendor partners to aid in the investigation and evaluation of the claim.
    • Investigate and refer identified claims to Loss Recovery Services, as applicable.
    • Serve as a resource to other claim handlers.
    • Attend mediations and present complex claim files during roundtables and claims committee meetings, as requested. Required Skills
      • 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. Required Experience
        • Five to seven years of claim handling and/or other insurance-related experience is required. Experience in handling Excess & Surplus lines preferred but other experience in handling moderate to complex property claims will be considered. 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. Church Mutual Insurance Company 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.Job LocationMadison, Wisconsin, United StatesPosition TypeFull-Time/Regular

Keywords: Church Mutual, Madison , Claim Representative III-Excess & Surplus - Madison, Other , Madison, Wisconsin

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