Senior Technical Claim Specialist - Large Loss

BASIC PURPOSE:

This role serves as the primary owner of first party property complex commercial claims, driving resolution outcomes, managing defense strategy, and ensuring alignment with organization objectives. The position bridges claims and legal by translating strategy into execution, proactively identifying opportunities for early resolution.

Responsible for handling large, complex claim files, including litigated matters, catastrophic claims, structural building damage, multiple location damage, including business income exposure and other extensive exposure claims, in accordance with applicable state and federal laws. Set reserves and settle claims within level of authority. Direct work of defense and coverage attorneys. Actively share knowledge with team members, contribute to training programs, and mentor other claim representatives. Stay abreast of current and emerging complex litigation claim settlement issues, trends, court decisions, and plaintiff bar activities. Partner with CM Group stakeholders to share information and analyze potential impacts on our products and chosen markets. This role requires strong knowledge of First-Party Property coverage forms and claims handling.

PRIMARY JOB RESPONSIBILITIES:

• Perform claim tasks timely and document claim files appropriately. Proactively manage claim activities to ensure fair claim Handle all claims in accordance with state and federal laws.
• Make complex coverage decisions based upon thorough investigation and analysis in a fair, equitable, and ethical manner. Provide detailed explanation to the insured, citing facts and relevant policy language. Caseload will consist largely of the most complex, high exposure matters involving issues including policy limits, excess coverage, layered coverages, and other specialty type, unique claims.
• Handle complex claims, coverage analysis, litigation management, mentoring, compliance
• Leverage advanced expertise in First-Party Property coverage to assess, investigate, and resolve complex and high-exposure claims, including litigated matters.
• Perform a thorough investigation based upon the type, complexity, and severity of the claim. Upon completion of the investigation, analyze and evaluate the potential liability and damages. Formulate and document an action plan based on the covered damages and injuries.
• Determine and set reserves based a risk-neutral evaluation of the most likely outcome, 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 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 Manage claim expense by reviewing attorney/firm performance, results and the value of services provided.
• Engage in direct investigation, control, and settlement negotiations as warranted
• Attend mediations, depositions, and Present complex claim files during roundtables and claims committee meetings.
• Stay abreast of current and emerging complex litigation/claim settlement issues, trends, court decisions, and plaintiff bar activities.
• Actively communicate and share knowledge of trends, litigation environment, and potential impacts with key CM Group stakeholders.

QUALIFICATIONS:

• Bachelor's degree A combination of equivalent education and/or experience may be considered in lieu of a degree.
• Experience with Corporate Representative Depositions and Trial testimony
• Evidence of continuing education in the insurance industry is required
• Strong knowledge of claims handling and coverage forms for Property
• Experience handling claims across multiple jurisdictions
• Additional legal education or law degree is highly
• AIC and/or CPCU designation is highly desirable
• Typically, fifteen or more 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 knowledge of recoveries such as subrogation, reinsurance, apportionment, and deductibles
• Advanced knowledge of reinsurance contracts, workers' compensation pools, second injury funds, etc.
• 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
• Ability to travel to attend mediations, depositions, 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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