Claims Representative - Workers' Compensation

Western National Group & Umialik Insurance•Edina, MN

1d•Hybrid

About The Position

Western National Insurance Group is seeking a Workers’ Compensation Claims Representative to join their team. The individual in this role will have the opportunity to investigate, evaluate, negotiate, and resolve Workers’ Compensation insurance claims as assigned. Western National Insurance Group is a private mutual insurance company with over 120 years of experience serving customers' property-and-casualty insurance needs in the Midwestern, Northwestern, and Southwestern United States. Known as “The Relationship Company®,” they define success as a measure of the relationships they’ve built over time. In everything that they do, they know that delivering a friendly and helpful interaction makes for a better experience for everyone involved. That’s the power of “nice”. At Western National, nice is something they work to bring to every person and organization with whom they partner and serve.

Requirements

A minimum of two years of experience with Workers’ Compensation claims.
Strong understanding of industry practices, standards, and claims concepts.
Ability to multitask and solve problems.
Ability to identify and investigate potential fraud indicators, including irregularities in medical treatment, billing practices, and reported injury details.
Proficient oral and written communication skills.
Strong negotiation and relationship-building skills.
Analytical with the ability to exercise sound business judgment.
Strong time management skills.
Bachelor’s degree or related experience.
Applicants must be authorized to work for any employer in the U.S. We are unable to sponsor or take over sponsorship of an employment Visa at this time.

Nice To Haves

Prior experience managing Workers’ Compensation claims in several of our operating states is preferred (e.g., Alaska, Illinois, Iowa, Michigan, Minnesota, New York, South Dakota, or Wisconsin).
Experience handling claims across multiple jurisdictions and navigating differing state regulations is strongly preferred.
AIC or AINS certification strongly preferred.
Ability to manage the end-to-end claims process in alignment with client expectations, corporate policies, industry best practices, and all statutory, regulatory, and ethical requirements.
Proficient use of various core systems, office and computer equipment, and software packages.

Responsibilities

Investigates, evaluates, negotiates, and resolves Workers’ Compensation claims as assigned.
Handles moderate-to-high complexity claims within settlement authority.
Ensures customer service excellence.
Investigates and reviews policy forms, facts, and documents related to claims to make appropriate decisions on claims resolution.
Assesses claim exposures and develops strategic action plans to drive efficient, fair, and cost-effective resolutions.
Establishes and reviews proper reserves for each claim based upon thorough investigation, evaluation, and experience, maintaining appropriate reports to ensure current status of claims are clearly documented at all times.
Provides direction to outside resources.
Makes decisions guided by general instructions and practices requiring interpretation.
Coordinates and collaborates with cross-functional specialists – loss prevention, legal counsel, unit managers, special investigations unit, HR partners, safety directors, and fellow examiners – to support accurate determination of injury mechanisms and case strategy.
Makes recommendations to solve more complex problems.
Recognizes problems or situations that are new or lack clear precedent.
Finds solutions using a systematic, multi-step approach.
Develops improvements and innovations to enhance performance.
Collaborates with all stakeholders involved in the claim lifecycle, including policyholders, agents, claimants, and internal partners.
Handles regular contact with outside vendors.
Travels on short notice for field work as required (e.g., scene investigations, inspecting property losses).
Performs special projects and other duties as assigned.

Benefits

Medical insurance plan options
Dental insurance
Vision benefits
Life insurance
Disability insurance
Health Savings Accounts (HSA)
Flexible Spending Accounts (FSA)
401(k) Plan (participants are eligible for 100% matching on the first 6% of their contributions)
Wellbeing Program, including onsite fitness studio
Paid Time Off – including holiday, vacation, and volunteer
100% company-paid tuition reimbursement for approved job-relevant coursework
Access to The Institutes (Risk and insurance education)
Paid parental leave
Bonus opportunities