Senior Claims Representative - Workers Compensation

Society Insurance; Wisconsin; Hybrid; USD 60,000 - 85,000; Full time

Job summary

Society Insurance is seeking a Claims Representative II (Workers’ Compensation) to investigate, evaluate, and resolve moderate-to-severe WC claims. The role collaborates with injured workers, employers, and medical providers to determine coverage and negotiate settlements under company guidelines and state regulations.

The position supports hybrid and remote opportunities across CO, GA, IL, IN, IA, MN, TN, TX, and WI.

Qualifications

• Bachelor's degree or equivalent experience in claims handling.
• 3+ years of claims handling experience, or 5+ years with discretionary decision-making.
• Familiarity with PC applications including word processing, Internet, spreadsheets, and e-mail software.
• Ability to obtain and maintain proper licensing prior to handling required states.

Responsibilities

• Investigate, evaluate, and resolve moderate-to-severe Workers’ Compensation claims.
• Determine coverage and liability and coordinate with injured workers, employers, and medical providers.
• Negotiate appropriate claim resolutions according to guidelines, policy provisions, and state regulations.
• Maintain proper file documentation and prepare reports summarizing claim information.
• Contribute to department guidelines and provide feedback to underwriting as needed.

Skills

Communication

Relationship building

Negotiation

Accountability

Analytical thinking

Investigative approach

Education

Bachelor's Degree

Tools

Word processing

Excel

Email tools

Job description

Position Location: Hybrid and Remote Opportunities in: CO, GA, IL, IN, IA, MN, TN, TX, and 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.

Society Insurance is seeking a Claims Representative II (Workers’ Compensation) to join our Claims team. This role will investigate, evaluate, and resolve moderate-to-severe complex Workers’ Compensation claims by determining coverage and liability, coordinating with injured workers, employers, and medical providers, and negotiating appropriate claim resolutions in accordance with company guidelines, policy provisions, and state regulations.

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 - OR - 5+ years of claims handling experience involving the exercise of discretionary decision-making.
• 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.