Claims Representative II (Workers Compensation)

Society Insurance Company • Fond du Lac, WI

2d

About The Position

Society Insurance is seeking a Claims Representative II to join its Claims team. The role investigates, evaluates, and resolves 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 position is full-time, exempt, and scheduled for 40 hours per week, with flexible scheduling opportunities. Home office, hybrid, and remote opportunities are available in CO, GA, IL, IN, IA, MN, TN, TX, and WI. Candidates whose experience and qualifications align with a senior-level opportunity may also be considered.

Requirements

• Bachelor’s degree and at least 3 years of claims handling experience, or at least 5 years of claims handling experience involving 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 before handling claims in a state that requires it.
• Valid driver’s license and a satisfactory driving record as determined by Society Insurance.
• Ability to communicate and build relationships, remain composed under pressure, negotiate constructively, act accountably and in accordance with rules and regulations, and analyze and investigate facts and evidence.

Nice To Haves

• Prior Workers’ Compensation indemnity experience.
• Professional insurance designations.

Responsibilities

• Handle and settle moderate-to-severe complex claims by determining the insurance carrier’s liability, reaching agreements with claimants or injured workers according to policy provisions and authority level, and handling subrogation.
• Determine insurance coverage by examining claim forms, policies, and other records; interviewing claimants or injured workers, insureds, and witnesses; reviewing police and hospital records; and consulting experts when appropriate.
• Investigate and compare claims information with evidence to resolve questionable claims.
• Participate in litigation by analyzing settlement options, evaluating evidence, and overseeing legal counsel in discovery and settlement.
• Ensure company guidelines and procedures are followed during investigations and in handling discovery and settlement.
• Maintain proper file documentation in compliance with claims handling guidelines and state requirements.
• Prepare reports by collecting, analyzing, and summarizing claim information.
• Develop and maintain professional and technical knowledge in specified lines of business through training and continuing education.
• Contribute to team efforts by participating in determining department investigation guidelines and providing feedback to underwriting as needed.

Benefits

• Comprehensive benefits package including salary with bonus plan and health, dental, life, and vision insurance.
• Traditional or Roth 401(k) Defined Contribution Plan and Profit-Sharing Plan.
• Company-paid holidays, flexible scheduling, PTO, and telecommuting options.
• Career coaching, company-paid courses, student loan reimbursement, and tuition reimbursement.
• Charitable match, paid volunteer time, and team sponsorships.
• Employee Assistance Program, wellness initiatives and rewards, and health coaching.

What This Job Offers

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