Clearing the Fog

Being a claims manager can be very satisfying yet frustrating at the same time. We all buy insurance hoping that we will never need to submit a claim. However, sometimes we need to and expect our policies to restore us for any damages we’ve experienced. When a loss happens, the role of a claims manager is to process and facilitate communication for insurance claims that have been submitted. 

As a claims manager, my daily life consists of a lot of research and communication, many times working with limited information, which can be frustrating. However, assisting to resolve a claim for one of our agency partners is very rewarding and makes the job more than worth it.  

Before I dive into what daily life is like being a claims manager, let’s discuss my career path and how I got this position.

Like most people, I simply fell into the insurance industry when I was younger. While in college, I needed summer work, so my best friend's mom suggested that I work at the agency she managed. My job was to update paper manuals and organize the files. This was around 2000, so things had not gone digital yet.

The owner liked my work and offered me a full-time position as a customer service representative (CSR) for personal lines. A year later, I was the department manager and started to work in commercial property and casualty (P&C) and trucking. A few years later, I became the agency operations manager which consisted of handling all lines of business. After that, I changed agencies and continued to manage books which consisted heavily of excess and surplus lines (E&S) business. When I joined JM Wilson in 2015, I was hired as a personal lines underwriter and handled claims on the side. Over the next few years, JM Wilson experienced significant growth which led my career to evolve into claims management with personal lines underwriting as needed. These experiences all helped me manage the day-to-day requirements of being a claims manager.

The day-to-day role of claims manager for a managing general agency (MGA) involves a lot of facilitating communication between parties, doing research, and navigating various files and lines of business. The day usually starts with processing new claims and addressing messages from agents and carriers that came in the night before. As the day continues, I field questions from agents, underwriters, carriers, and attorneys. 

One moment, I could be generating loss runs for one of our underwriters, and the next, I could be sifting through policy language to try and find coverage for an insured’s claim. I do not get involved in adjusting losses unless it's part of a Lloyds of London contract. In those situations, I hire adjusters, review their reports, and communicate next steps to London for their approval. 

I also build many new claims from scratch during the day. It is not uncommon for an agent to ask for status on a claim that we had no knowledge of. Most carriers do not let us know when they receive a claim directly from an insured or claimant, so when that happens, I gather the information on the fly as best I can. I also update our existing claim files with changes in reserves and payments. 

Insurance claims can be challenging no matter how long you have been in the business. I have found the rewards to be greater! I love to research and find answers. If I can find that one piece of language that turns a claim around, I’m over the moon with excitement. 

I also enjoy the fact that I get to use my knowledge and experience every day. I have a unique responsibility here at JM Wilson where I need to have some knowledge about every line of business we offer. Where others specialize, my knowledge is broader since I’ve learned things from being an agent, CSR, and manager of a retail agency as well as underwriter.

The most satisfying thing for me is resolving an issue for one of our agency partners. That’s truly when I love what I’m doing. Being that extra helping hand makes my role as claims manager rewarding.

My position is a liaison and advocacy role. I cannot have direct contact with the insured. Likewise, I am not adjusting the claim, so the carrier adjuster has the details of the loss which they often do not communicate to me. 

It can be like looking into a foggy mirror most of the time. Since I am truly a third party in the claim, I am often working with very little information, and waiting for communication from multiple parties to make things clearer. Thus, my focus is set upon facilitating communication and advocating for coverage when the circumstances of a claim make coverage questionable.

Keep in mind, JM Wilson is not an insurance company. As an MGA, we cannot call your insured and your insured cannot call us. We work directly with the agent, who is the primary contact for the insured.

E&S losses have multiple layers of people involved, including third-party adjusting firms or attorneys. It’s not like submitting a claim to a standard market where everything is managed in-house and can get settled in a week or two. E&S claims are usually complex and can often take months to resolve. It’s easy to be frustrated if you have the same expectations that you would with a standard market. 

An agent can help the claims process get the right start by completing an ACORD loss notice or completing the loss form in the agency portal of JM Wilson’s website. These documents ask for all the needed information. I often receive emails that don’t have crucial information like the insured’s contact details, a policy number, or even the date of loss. I’m not able to set up a proper loss file with just a police report or an email thread without any reference to what claim they are discussing. The more information I can start the process with, the faster I can get the communication with carriers and adjusters moving.

Something that serves me well in my position is being thorough and never jumping to conclusions. Things are often not as they appear at first glance. Every claim is different, even if they seem similar on the surface. Navigating the intricacies and plot twists with all parties involved is what makes this job so interesting. It is important to keep calm, gather the facts, and communicate well. Everything will become known in the end.