Senior Claims Representative Analyst

Society Insurance Company•Fond du Lac, WI

3d•Hybrid

About The Position

Society Insurance is seeking an experienced Senior Claims Representative Analyst to join our team. This position will Independently resolve large and significantly complex claims by investigating losses and negotiating settlements. This role also works closely with Claims Manager, Senior Claims Quality Specialist, Compliance Manager, Claims Vendor Manager, and Claims Director to analyze jurisdictional changes and impacts on departmental and company guidelines and standards.

Requirements

Bachelor’s degree in business or related field and 7+ years of handling complex claims as determined by Society Insurance – OR – 10+ years of claims handling experience involving the exercise of discretionary decision-making and increasing levels of claims complexity, including specialized coverages and loss adjustments as determined by Society Insurance.
Valid driver’s license and a satisfactory driving record as determined by Society Insurance.
Willingness to travel in person to mediations, agency visits, key discovery depositions, and field investigations, when necessary, throughout our service area.
Technical proficiency in commercial property and/or casualty claims demonstrated through knowledge and experience in insurance policies and coverage, claim payment procedures, insurance regulations, and legal terminology.
Ability to obtain and maintain proper licensing prior to handling a state where Society requires it.
Familiarity with PC applications including word processing, Internet, spreadsheets, and e-mail software.
Places a priority on developing and maintaining good working relationships throughout the department and organization.

Nice To Haves

Professional designations of AIC, ARM, CIC, CPCU, or equivalent coursework preferred.
Holds and maintains a valid state adjuster license where required preferred.
Knowledge of medical terminology preferred.
Advanced knowledge of litigation processes, procedures, terminology, and the ability to perform legal research preferred.

Responsibilities

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.
Handles and settles large and significantly complex claims by determining insurance carrier’s liability; reaching agreement with claimants/injured workers according to policy provisions and authority level; handling mediations, arbitrations, and subrogation within authority level.
Provides departmental support by mentoring and training new and current claims representatives, shared claims staff, and interns.
May support after-hours claims emergencies by being on call 24 hours per day, seven days per week.
Keeps focus with continued file handling by collecting, analyzing and summarizing information, as well as making recommendations to managers regarding reserve changes and future handling of files over their authority level.
Resolves questionable claims by investigating and comparing claims information with evidence.
Manages litigated files and recommends litigation by analyzing negotiated settlement options and evaluating evidence.
Manages file load composed of higher exposure and highly complex claims.
Ensures company guidelines and procedures are followed by overseeing independent adjusters during investigations and attorneys in the handling of discovery and settlement.
Ensures proper file documentation of assigned files by complying with claims handling guidelines and state requirements.
Prepares reports by collecting, analyzing, and summarizing claim information.
Contributes to team effort by participating on catastrophe teams; participating in determining department investigation guidelines; providing feedback to underwriting as needed; building relationships with agents; participating in evaluation and selection of vendors.
Maintains professional, technical knowledge and expertise in a specified line(s) of business through training courses and participating in continuing education coursework/classes.
Resolves litigated claims by referring cases to attorneys as needed, analyzing state statutes, evaluating evidence, and working with the attorneys in developing strategy for resolution of the case.
Stays current on evolving state needs for the company, staff, and individual personal development. This may require travel to attend seminars, training opportunities, monitoring trade publications, and developing key relationships with local contacts who are experts in the region and subject matter.
Monitors, summarizes, and analyzes external factors impacting all jurisdictions (except Wisconsin). Attending APCIA, state legislative, workers’ compensation bureau/webinars; reviewing technical bulletins; gathering facts, researching, and analyzing applicable laws, regulations, case law, etc. for department and new state expansion needs. Communicates to the state Claims Manager(s), Senior Quality Specialist and Director any new/updated changes and impacts to handling claims.
In collaboration with Claims leadership (Director, Claims Managers, Senior Quality Specialist), analyzes current business processes and workflows, and prepares recommendations for compliance. Focuses on continuous improvement to streamline processes.
Collaborates with Claims leadership (Director, Claims Managers, Senior Quality Specialist) on training. May facilitate state meetings.
Works with Claims Vendor Manager and Claims Managers on troubleshooting WC vendor issues that impact adjusters’ ability to handle claims.
At the direction of Claims Director, Claims Managers and/or Compliance Manager, assists with state interest credit, state penalties, Physician Panels, annual state reporting needs (e.g., Colorado surveys, change of physician, Longshore reporting) which are not already overseen by another department such as Insurance Product Management.
Works with Compliance Manager on annual best practice review by the end of 3rd quarter to conform with Corporate Compliance Review deadline.
Works with state Claims Managers and Quality Claims Specialist to update any state materials on the Claims Insider/Sharepoint site and ensure updates are communicated to the floor.