Senior Claims Examiner - Casualty

This position is available in Merrill, WI or Madison, WI.

Responsible for the handling of general liability and auto liability claims, including those matters that involve litigation. This role will handle complex claims for both Church Mutual Insurance Company and CM Vantage Specialty Insurance Company. Direct adjustment and settlement of casualty claims within authority and within your territory of responsibility. Assist with the adjustment of losses beyond authority as directed after reviewing these losses with the manager.

Duties and Responsibilities:

Claims Adjustment

• Determine if coverage exists and/or liability by gathering adequate information necessary to make an informed decision in a fair, equitable, and ethical manner
• Deny claims where no liability or coverage exists, providing an adequate explanation to the insured or claimant
• When coverage exists for a loss and/or liability exists, determine the correct amount due by applying policy provisions and through proper investigation and documentation of the damages
• Establish and monitor reserves for adequacy
• Authorize and release approved payments
• Carry out the necessary oral and written correspondence to accomplish adjustment of the claims, i.e., phone calls, letters, instructions to support staff, adjusters, insureds, claimants, etc.
• Provide adequate documentation for all action taken on the file
• Follow established claims procedures where appropriate; refer exceptions to manager
• Participate in round‑table discussion of files and attend mediations when required

Miscellaneous

• Review work of outside vendors and related expenses charged to assure a proper defense is being provided.
• Timely identification and referral of claims to the Subrogation Specialist
• Communicate with other departments such as Underwriting, Sales, Risk Control, as necessary
• Continue to expand claims knowledge and knowledge of insurance in general including taking and passing any state adjusting license exams and obtaining subsequent continuing education credits

Additional Duties

• Assist in training new casualty claims examiners/service representatives
• Be consultant to other casualty claims examiners and service representatives for Claims Processing System and other technical issues

Required Experience

• Minimum three years of casualty claims examiner or service representative experience or equivalent.
• Four-year college degree or equivalent experience.
• Additional insurance training desirable.
• INS 21, Property and Liability Insurance Principles, and INS 23, Commercial Insurance, courses must have been completed or the equivalent.
• Medical Terminology I or II class desirable.
• AIC and/or CPCU courses desirable.