Senior Claims Representative Analyst

Society Insurance Company; Fond du Lac (WI); Remote; USD 95,000 - 135,000; Full time

Benefits offered by this job

Health/dental/life/vision coverage

401(k) with company match and profit‑n

Flexible scheduling & PTO

Job summary

Society Insurance seeks an experienced Senior Claims Representative Analyst to independently resolve large and significantly complex claims by investigating losses and negotiating settlements. This role collaborates with Claims Manager, Senior Quality Specialist, Compliance Manager, Claims Vendor Manager, and Claims Director to analyze jurisdictional changes and impacts on guidelines and standards.

The position may require travel for mediations, agency visits, and field investigations within the

Qualifications

• Bachelor’s degree in business or related field and 7+ years of handling complex claims.
• Valid driver’s license and willingness to travel for mediations and investigations.
• Technical proficiency in commercial property and/or casualty claims.

Responsibilities

• Determine coverage by reviewing claim forms, policies, and records.
• Resolve large, complex claims and negotiate settlements.
• Mentor and train junior staff and interns.
• Assist with after-hours emergencies when on call.
• Monitor state regulatory changes affecting claims handling.

Skills

Analytical thinking

Negotiation

Communication

Mentoring

Education

Bachelor’s degree in business or related field

Tools

Claims software

Job description

40 hours/week with Flexible Scheduling Opportunities

Position Location:

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

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.

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.

About the Role

• 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/board updates/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.

About Yo u

• You are accountable and accept ownership.
• You are an analytical thinker and make sound business decisions.
• You communicate in a clear, concise, and unambiguous way.
• You are compliant, composed, and resilient.
• You are curious and seek to understand.
• You are a self-starter who is motivated, driven, and goal-focused.
• You can negotiate skillfully to achieve win-win solutions.
• You can manage multiple responsibilities and stay on top of time-sensitive tasks.

What it Will Take

• 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.
• 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.

What Society Can Offer

• Comprehensive Benefits Package : Salary with bonus plan; health, dental, life, and vision insurance
• R etirement : Traditional or Roth 401(k) Defined Contribution Plan PLUS Profit-Sharing Plan
• W ork-Life Balance : Company-paid holidays; flexible scheduling; PTO; telecommuting options
• E education : Career Coaching; company-paid courses; student loan and tuition reimbursement
• W ellness : 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.