Claims Representative II (Workers Compensation)

Society Insurance; Fond du Lac (WI); Hybrid; USD 65,000 - 90,000; Full time

Benefits offered by this job

Salary with bonus plan

Retirement plan

Holidays & PTO

Job summary

Society Insurance is seeking a Claims Representative II (Workers Compensation) in Fond du Lac, WI. This full-time role handles moderate-to-severe workers' compensation claims, determines liability, and coordinates with claimants, insureds, and medical providers.

The position supports subrogation efforts and may involve litigation oversight when needed. You will analyze claims, interview involved parties, maintain thorough documentation, and work within state regulations.

Qualifications

• Bachelor’s degree required; 3+ years of claims handling experience.
• 5+ years of claims handling with discretionary decision-making exposure preferred.
• Familiarity with PC applications including word processing, Internet, spreadsheets, and e‑mail software.

Responsibilities

• Handles and settles moderate-to-severe complex workers’ compensation claims.
• Determines coverage by examining claim forms, records, and witnesses; interviews involved parties.
• Resolves questionable claims by investigating and comparing information with evidence.
• May participate in litigation and oversee counsel during discovery and settlement.
• Ensures proper file documentation and compliance with guidelines and state requirements.

Skills

Communication

Negotiation

Accountability

Analysis

Investigation

Education

Bachelor’s Degree

3+ years claims handling experience

Tools

MS Office Suite

Job description

Claims Representative II (Workers Compensation)

Full Time 2 Fond du Lac, WI, US

7 days ago Requisition ID: 1658

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

While the role is currently posted at the Claims Representative II level, we are open to considering candidates whose experience and qualifications align with a senior-level opportunity.

Overview

Protecting our policyholders’ dreams, passions, and livelihoods has a direct impact on the communities we serve. We work towards excellence, conduct ourselves with high integrity, and take our work seriously, but not ourselves. Small Details. Big Difference. Find out how you can make a difference with a career at Society.

About the Role

• Handles and settles moderate-to-severe complex claims by determining insurance carrier’s liability; reaching agreement with claimants/injured workers according to policy provisions and authority level; 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.
• May be involved with litigation by analyzing negotiated settlement options, evaluating evidence, and overseeing legal counsel – in the handling of discovery and settlement.
• 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 participating in continuing education coursework/classes.
• Contributes to team effort by participating in determining 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 and 3+ years of claims handling experience
• 5+ years of claims handling experience involving the exercise of 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 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

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