Church Pension Group Services Corporation Careers

The Casualty Claims Examiner is responsible for the examination of coverage, investigation of claims, evaluation of damages and liability, and negotiating and settling third party claims. At entry level, this position focuses primarily on medical payment claims and over time may progress into the handling of bodily injury claims and litigated bodily injury claims. 

ESSENTIAL DUTIES AND RESPONSIBILITIES include the following. Other duties may be assigned.

            Medical Payment File Handling

• Review coverage forms and claim records to determine insurance coverage for all claims, drafting timely coverage position letters when necessary.
• Interview client representatives and third parties; gather photos, statements, reports, medical records and other materials to analyze the extent of the insured’s liability and overall exposure.
• Establish timely reserves, reviewing for appropriateness and accuracy as claims develop and adjusting when appropriate. 
• Update claim file notes routinely to address claim status, and each time relevant claim information is received. Claim file notes should include the Casualty Claim Examiner’s assessment of the information received and a clear outline of strategy and plan.
• Ensure all relevant documents are maintained in the claim file document folder.
• Maintain frequent communication with policyholders and third parties.
• Issue timely payments when appropriate, securing W9 forms when necessary.
• Actively participate in 1:1 meetings, roundtables, and team discussions

            Bodily Injury File Handling (includes above duties and responsibilities along with the below)

• Engage in direct settlement discussions with third parties or their representatives once a case has been evaluated for settlement.
• Retain and work collaboratively with defense firms on litigated claims, with an eye on resolution throughout the litigation process. The Casualty Claim Examiner should be leading the strategic course throughout the litigation and all legal documents are to be independently reviewed, including legal briefs/pleadings, deposition transcripts, medical records, expert reports, and any other evidentiary materials.
• Proactively handle to completion all assigned claims, including attendance at mediations and trial.
• Draft comprehensive large loss and other loss reports senior leadership and reinsurers as required or requested.
• Generate and distribute advisory reports when reserve changes are in excess of $100,000.

QUALIFICATIONS: To perform this job successfully, an individual must be able to complete the essential duties independently and in a timely fashion. This is an entry level Examiner position so training and mentoring will be provided early on, and graduation to increased duties will depend on the aptitude demonstrated through performance and the individual development plan of the Examiner.  The requirements listed below are representative of the foundational knowledge, skill, and/or ability required. Reasonable accommodation may be made to enable individuals with disabilities to perform the essential functions.

• Strong verbal and written communication skills – with strengths in professionalism, trustworthiness, compassion, listening, and empathy.
• Superior analytical skills – ability to pinpoint relevant detail to evaluate exposure accurately.
• Proficient in Excel, Word, Outlook.
• Strong time management and organization skills.
• Ability to remain focused during high volume/high intensity times.
• Attention to detail with entry of critical data into the claims system.

EDUCATION and/or EXPERIENCE

• 5+yrs of relevant experience. P&C Insurance background strongly preferred. 
• Bachelor’s Degree preferred. Combination of work and experience considered .

PHYSICAL DEMANDS: Commuting to the VT office, on average, three days a week. Extensive use of a computer keyboard is a demand of the position to perform the essential functions of this job successfully. Reasonable accommodations may be made to enable someone with a disability to perform the essential functions of this position. 

WORK ENVIRONMENT: Hybrid (two days working from home, three days working in a standard office environment). Church Pension Group employees must maintain a professional, compassionate, and trustworthy work environment always. Reasonable accommodations may be made to enable someone with a disability to perform the essential functions of the job within this environment.