Claims Representative I - Workers Compensation Medical Only

West Bend Mutual Insurance Company; Appleton (WI); Hybrid; USD 10,000 - 60,000; Full time

Job summary

A leading insurance firm is seeking a Medical Claims Detective to manage low-complexity workers’ compensation claims. The position involves thorough investigations and proactive file management, with a focus on customer service. Candidates with 0-2 years of experience and a Bachelor's degree in a relevant field are preferred. The job offers a hybrid schedule, benefits, and competitive pay.

Benefits

Medical & Prescription Insurance

Health Savings Account

Dental Insurance

Vision Insurance

Short and Long Term Disability

Flexible Spending Accounts

Life and Accidental Death & Disability

Accident and Critical Illness Insurance

Employee Assistance Program

401(k) Plan with Company Match

Pet Insurance

Paid Time Off

Qualifications

• 0-2 years of experience in claims handling preferred.
• Strong proficiency with computers and current technology.
• Excellent interpersonal and communication skills.

Responsibilities

• Manage assigned Workers Compensation Medical Only/low complexity claims.
• Conduct thorough investigations to determine coverage and payment.
• Participate in training activities and maintain file management.

Skills

Claims handling

Proficiency with computers

Interpersonal skills

Oral communication skills

Written communication skills

Time management skills

Customer service skills

Problem-solving skills

Education

Bachelor’s degree in Business, Insurance or related field

Job description

Company Overview

Recognized as a Milwaukee Journal Sentinel Top Workplace for 14 consecutive years, including three years of being honored as number one. Join us at West Bend, where we believe that our associates are our greatest asset. We hire talented individuals who are conscientious, dedicated, customer focused, and able to build lasting relationships. We create and maintain an environment where you feel a sense of belonging and appreciation. Your diversity of thought, experience, and knowledge are valued. We’re committed to fostering a welcoming culture, offering you opportunities for meaningful work and professional growth. More than a workplace, we celebrate our successes and take pride in serving our communities.

Job Summary

As a Medical Claims Detective, you’ll dive into low‑complexity workers’ compensation claims, investigating details to determine coverage, payment amounts, and file management. You’ll have the support of a manager and modern claims technology.

Work Location

This is not a remote position. Candidates located within 50 miles of a West Bend office work a hybrid schedule (at least 3 days/week). The position can be based in West Bend, Madison, or Appleton.

The internal deadline to apply is 11/19/2025. External applications are accepted on a rolling basis while the position remains open.

Responsibilities & Qualifications

Manage assigned Workers Compensation Medical Only/low complexity claims with supervision and guidance from the manager using current Claims technology. Conduct thorough investigations to determine coverage and claim payment amounts. Responsibilities also include proactive file management, adequate reserving, and participation in training activities.

Key Responsibilities

• Consistently exhibit a high level of customer service.
• Adhere to department audit guidelines.
• Conduct thorough investigations to determine coverage and payment.
• Maintain proactive file management and adequate reserving.
• Participate in training activities.

Preferred Experience and Skills

• 0‑2 years of experience in claims handling
• Proficiency with computers and current technology
• Interpersonal skills
• Oral and written communication skills
• Time management skills
• Customer service skills
• Problem‑solving skills

Preferred Education and Training

• Bachelor’s degree in Business, Insurance or related field

Salary Statement

The salary range for this position is $23.15 – $31.00. The actual base pay will be based on factors such as knowledge, skills, experience, business needs, location, and internal equity.

Benefits

• Medical & Prescription Insurance
• Health Savings Account
• Dental Insurance
• Vision Insurance
• Short and Long Term Disability
• Flexible Spending Accounts
• Life and Accidental Death & Disability
• Accident and Critical Illness Insurance
• Employee Assistance Program
• 401(k) Plan with Company Match
• Pet Insurance
• Paid Time Off – Standard first year PTO is 17 days, pro‑rated by month of hire. Enhanced PTO may be available for experienced candidates.
• Bonus eligible based on performance
• West Bend will comply with applicable state and local employment‑leave laws, including the Colorado Healthy Families and Workplaces Act.

EEO

West Bend provides equal employment opportunities to all associates and applicants for employment and prohibits discrimination and harassment of any type without regard to race, color, religion, age, sex, national origin, disability status, genetics, protected veteran status, sexual orientation, gender identity or expression, or any other characteristic protected by federal, state, or local laws. This policy applies to all terms and conditions of employment, including recruiting, hiring, placement, and promotion.