Claims Representative I (Workers' Compensation)

Society-Insurance; Fond du Lac (WI); Hybrid; USD 48,000 - 58,000; Full time

Benefits offered by this job

Health insurance

401(k) retirement plan

Paid holidays and PTO

Telecommuting options

Job summary

Society Insurance is seeking a Claims Representative I (Workers’ Compensation) in Fond du Lac, WI. The role investigates, evaluates, and resolves mildly complex claims, determining coverage and liability while coordinating with injured workers, employers, and medical providers.

You will negotiate resolutions within policy provisions and state regulations, document findings thoroughly, and develop expertise through training. Hybrid/remote opportunities are available in several states.

Qualifications

• Bachelor’s degree or 3+ years of claims handling experience.
• Discretionary decision-making experience preferred.
• Familiarity with PC applications including MS Word, Excel, and email.

Responsibilities

• Investigate, evaluate, and resolve mildly complex workers’ compensation claims.
• Determine coverage and liability and coordinate with workers, employers, and providers.
• Negotiate resolutions within company guidelines and state regulations.
• Prepare reports and maintain proper file documentation.
• Continue professional development to maintain domain expertise.
• Support teammates by sharing guidelines and feedback with underwriting.

Skills

Communication

Relationship building

Negotiation

Analytical thinking

Accountability

Curiosity

Education

Bachelor’s Degree in business or related field

3+ years claims handling experience

Knowledge in property & casualty insurance

Tools

PC applications

Word processing

Spreadsheets

Email

Job description

Claims Representative I (Workers' Compensation)

Location: Full Time – Fond du Lac, WI, US

Requisition details have been removed for ATS clarity.

Job Information

Job Title

Claims Representative I (Workers’ Compensation)

Home Department

Claims

Employment Status

Exempt; Full-time

Schedule

40 hours/week with Flexible Scheduling Opportunities

Position Location

Home Office, Hybrid, and Remote Opportunities in: CO, GA, IL, IN, IA, MN, TN, TX, WI

Overview

Society Insurance seeks a Claims Representative I (Workers’ Compensation) to investigate, evaluate, and resolve mildly complex claims by determining coverage and liability, coordinating with injured workers, employers, and medical providers, and negotiating resolutions in accordance with company guidelines, policy provisions, and state regulations.

About the Role

• Handles and settles mildly complex claims by determining carrier liability, reaching agreement with claimants/injured workers according to policy provisions and authority, 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 continuing education.
• Contributes to team effort by helping determine department investigation guidelines and providing feedback to underwriting as needed.

About You

• You enjoy communicating and building relationships with others.
• You are composed, cool under pressure, and can negotiate without damaging relationships.
• You hold yourself accountable and act in accordance with rules and regulations.
• You enjoy analyzing, investigating, and using the facts to make decisions.
• You are naturally curious and have a desire to know more.
• You apply an investigative approach to identifying facts and evaluating evidence.

What it Will Take

• Bachelor’s Degree in business or related field OR 3+ years of claims handling experience involving discretionary decision-making.
• OR 5+ years of knowledge in the property & casualty insurance industry.
• Familiarity with PC applications including word processing, Internet, spreadsheets, and e-mail.
• 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.
• Prior workers’ compensation indemnity experience highly desirable.

What Society Can Offer

• 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
• Wellness: Employee Assistance Program; wellness initiatives/rewards; health coaching; and more

Equal Employment Opportunity

Society Insurance prohibits discrimination and harassment of any type against applicants and employees on the basis of race, color, religion, sex, national origin, age, disability, genetics, veteran status, marital status, sexual orientation, gender identity or expression, or any other characteristic protected by law. Society Insurance provides reasonable accommodations to qualified individuals with disabilities in accordance with applicable laws. Society Insurance is a drug-free workplace.