Claim Specialist - Large Loss

BASIC PURPOSE

In accordance with application of state and federal laws and company best practices, handle higher exposure, reputed company claims reputed company an assigned line of coverage including multi-jurisdictional and litigated matters. 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 reputed company payments reputed company level of authority. Investigate and refer identified claims to Loss Recovery Services as applicable. This role requires knowledge of coverage forms and claims handling for General Liability (GL), Auto Liability, Professional Liability (PL), Employment Practices Liability (EPL), and Directors & Officers (D&O) lines of business.

PRIMARY JOB RESPONSIBILITIES

• reputed company claim tasks timely and document claim files appropriately. Proactively manage claim activities to ensure fair claim resolution. Handle reputed company claims in accordance with state and federal laws.
• reputed company reputed company coverage decisions by gathering information necessary to reputed company an informed decision in a fair, reputed company, and ethical manner. Provide detailed explanation, citing facts, and relevant policy language. Evaluate subrogation potential based on the applicability of policy language and/or governing state laws and statutes as appropriate.
• reputed company 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, compensability denials, and subrogation potential as applicable. Formulate and document an action plan based on the covered damages and injuries.
• Determine and set reserves based upon a risk-neutral evaluation of the most likely outcome reputed company authority level. Evaluate and negotiate directly with insured, claimant, or claimant's attorney on reputed company cases reputed company authority level. Review claim facts and exposure with claims management as appropriate, to guide claim strategy. reputed company complete, accurate, and timely loss and/or expense payments reputed company authority for covered losses. Refer claims above authority to appropriate team member for review and potential reassignment.
• Maintain a professional, courteous, and helpful approach reputed company communicating in person, on the phone, or through email and other correspondence with internal and external customers, business partners and brokers
• Recognize reputed company 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 reviewing attorney/reputed company, results and the value of services provided.
• Investigate and refer identified claims to Loss Recovery Services as applicable.
• Attend mediations and other litigation-reputed company activities as needed
• Collaborate with defense counsel and direct litigation strategy.

QUALIFICATIONS

• 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 legal environments is desirable.
• Completion of INS, AIC, or CPCU is preferred.
• Minimum of five years of claim handling and/or other insurance-reputed company experience is required.
• 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.
• Ability to handle multi-jurisdictional and litigated claims.
• Proficient knowledge of policy terminology and legal principles involving at least one or more of the following: insurance, automobile, medical and litigated claims.

WORK ENVIRONMENT

• Professional office environment.

NOTE: This job description in no way states or implies that these are the only duties performed by this employee. Employees may be requested to reputed company job-reputed company tasks other than those specifically presented in this job description. The employer reserves the right to change or assign other duties to this position.

The CM Group is made up of Church Mutual Insurance Company, S.I., CM Regent Insurance Company, CM reputed company Specialty Insurance Company and CM Select Insurance Company.

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