Claims Representative II (Workers Compensation)

Society Insurance Company•Fond du Lac, WI

6d•Hybrid

About The Position

Society Insurance is seeking a Claims Representative II (Workers’ Compensation) to join our Claims team. This role will investigate, evaluate, and resolve moderate-to-severe 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. The role handles and settles moderate-to-severe complex claims by determining insurance carrier’s liability; reaching agreement with claimants/injured workers according to policy provisions and authority level; and handling subrogation. It 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. The role resolves questionable claims by investigating and comparing claims information with evidence. It may be involved with litigation by analyzing negotiated settlement options, evaluating evidence, and overseeing legal counsel – in the handling of discovery and settlement. The Claims Representative II ensures company guidelines and procedures are followed during investigations and in the handling of discovery and settlement. They ensure proper file documentation by complying with claims handling guidelines and state requirements. The role prepares reports by collecting, analyzing, and summarizing claim information. The Claims Representative II 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. They contribute to team effort by participating in determining department investigation guidelines; and providing feedback to underwriting as needed.

Requirements

Bachelor’s Degree and 3+ years of claims handling experience OR 5+ years of claims handling experience involving the exercise of discretionary decision-making as determined by Society Insurance
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 moderate-to-severe 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.
May be involved with litigation by analyzing negotiated settlement options, evaluating evidence, and overseeing legal counsel – in the handling of discovery and settlement.
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.