Claim Representative I, II or III – Merrill, WI 54452

We are hiring a Claim Representative and will consider various levels depending on factors such as experience and skill set.

In accordance with application of state and federal laws and company best practices, handle low to moderate value claims within an assigned line of coverage, such as medical payments, short duration indemnity, minor auto physical damage, property damage, business personal property, and low exposure bodily injury claims. 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.

  • 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.
  • Verify coverage by gathering adequate information necessary to make an informed decision in a fair, equitable, and ethical manner. Review and approve probable denials with supervisor.
  • Perform a thorough investigation and obtain pertinent file documentation (i.e., police report, medical records, estimates, photos, etc.). Upon completion of the investigation, analyze and evaluate the potential exposure and damages, and formulate and document an action plan.
  • Determine and set reserves based on the most probable outcome of the claim, within authority level. 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 and business partners.
  • Recognize when vendor partners are required on a claim. 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.
  • Completes all other assigned duties, 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.
  • Basic knowledge of policy terminology and legal principles involving at least one or more of the following: insurance, automobile, medical, and property claims.
  • A Claim Representative II or III would need to have advanced skills and knowledge in these areas.

Required Experience

Claim Representative I

  • Associate or 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 courses in any one or more of the following designations, INS, AIC, or CPCU, is preferred.
  • One to two years of insurance or related experience is required.

Claim Representative II

  • Two to four years of insurance and/or claim handling experience is required.
  • 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 courses in any one or more of the following designations, INS, AIC, or CPCU, is preferred.

Claim Representative III

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

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