Claims Representative I (Workers' Compensation)

Society Insurance Company • Fond du Lac, WI

8h • Hybrid

About The Position

Society Insurance is seeking a Claims Representative I (Workers’ Compensation) to join our team.

This role will investigate, evaluate, and resolve mildly complex Workers’ Compensation claims by determining coverage and liability, coordinating with injured workers, employers, and medical providers, and negotiating appropriate claim resolutions in accordance with company guidelines, policy provisions, and state regulations.

Requirements

• Bachelor’s Degree in business or related field OR 3+ years of claims handling experience involving the exercise of discretionary decision-making as determined by Society Insurance OR 5+ years of knowledge in the property & casualty insurance industry
• Familiarity with PC applications including word processing, Internet, spreadsheets, and e-mail software.
• Ability to obtain and maintain proper licensing prior to handling a state that requires it.
• Valid driver’s license and a satisfactory driving record as determined by Society Insurance.

Nice To Haves

• Prior workers’ compensation indemnity experience highly desirable.
• Professional insurance designations highly desirable.

Responsibilities

• Handles and settles mildly complex claims by determining insurance carrier’s liability; reaching agreement with claimants/injured workers according to policy provisions and authority level; and handling subrogation.
• Determines insurance coverage by examining claim forms, policies, and other records; interviewing claimants/injured workers, insureds, and witnesses; reviewing police and hospital records; and consulting with experts when appropriate.
• Resolves questionable claims by investigating and comparing claims information with evidence.
• Ensures company guidelines and procedures are followed during investigations and in the handling of discovery and settlement.
• Ensures proper file documentation by complying with claims handling guidelines and state requirements.
• Prepares reports by collecting, analyzing, and summarizing claim information.
• Develops and maintains professional, technical knowledge and expertise in a specified line(s) of business through training courses and participating in continuing education coursework/classes.
• Contributes to team effort by participating in determining department investigation guidelines; and providing feedback to underwriting as needed.

Benefits

• Comprehensive Benefits Package: Salary with bonus plan; health, dental, life, and vision insurance
• Retirement: Traditional or Roth 401(k) Defined Contribution Plan PLUS Profit-Sharing Plan
• Work-Life Balance: Company-paid holidays; flexible scheduling; PTO; telecommuting options
• Education: Career Coaching; company-paid courses; student loan and tuition reimbursement
• Community: Charitable Match; paid volunteer time; team sponsorships
• Wellness: Employee Assistance Program; wellness initiatives/rewards; health coaching; and more

What This Job Offers

• Job Type: Full-time
• Career Level: Entry Level