Senior Technical Workers' Comp Claims Specialist

Church Mutual Insurance Company, S.I.; United States; On-site; USD 90,000 - 120,000; Full time

Job summary

Church Mutual Insurance Company, S.I. is seeking an experienced claims professional to investigate, evaluate, and disposition complex Workers' Compensation cases of high exposure.

You will gather and review claim information, determine coverage, and conduct investigations, updating the claim system to document handling activities. You will set reserves, authorize payments within your authority, and apply medical management strategies for high-dollar claims.

Qualifications

• Bachelor's degree preferred or equivalent experience.
• Eight years in technical insurance claim roles with increasing responsibility.
• Ability to obtain state adjusting license and complete CE requirements.
• Advanced knowledge of recoveries such as subrogation, reinsurance, and deductibles.

Responsibilities

• Perform claim tasks timely and document claim files appropriately.
• Apply jurisdictional knowledge for full regulatory compliance across jurisdictions.
• Make complex coverage and/or compensability decisions with explanations citing facts and law.
• Conduct thorough investigations and evaluate exposure, denials, and subrogation potential.
• Set reserves and negotiate with insured or attorney within authority; process payments.
• Coordinate with vendors and defense attorneys to support claim strategy and resolution.
• Present complex claims files and prepare large loss reports per internal protocols.

Skills

Jurisdictional knowledge

Negotiation

Communication

Investigation

Medical management

Education

Bachelor's degree

AIC/CPCU preferred

Tools

Claims management system

Job description

Church Mutual Insurance Company, S.I. is seeking an experienced claims professional to investigate, evaluate, and disposition complex Workers' Compensation cases of high exposure.

You will gather and review claim information, determine coverage, and conduct investigations, updating the claim system to document handling activities. You will set reserves, authorize payments within your authority, and apply medical management strategies for high-dollar claims.