BASIC PURPOSE:
Responsible for handling large, complex casualty claim files, including litigated matters, umbrella claims and severe injury 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.
PRIMARY JOB 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.
QUALIFICATIONS:
Bachelor's degree preferred. A combination of equivalent education and/or experience may be considered in lieu of a degree.
General Liability and/or Professional Liability experience preferred
Adjusters must obtain and maintain a valid license and demonstrate compliance with continuing education requirements.
Completion of AIC and/or CPCU is preferred.
Minimum of eight years in technical insurance claim roles with increasing responsibilities is required.
Ability to obtain and maintain state adjusting license requirements and complete continuing education requirements.
Advanced negotiation skills.
Strong listening, verbal, and written communication skills.
Advanced knowledge of policy terminology, legal principles involving insurance, and emerging industry trends.
Effective planning and organization skills.
Ability to travel to attend mediations and trials, etc.
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 perform job-related 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 Vantage Specialty Insurance Company and CM Select Insurance Company.
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