W.C. Claims Representative

Acuity Insurance; Sheboygan (WI); On-site; USD 75,000 - 90,000; Full time

Benefits offered by this job

401(k) contribution

Medical insurance

Dental insurance

Vision insurance

Life insurance

Disability insurance

Paid time off

Employee Assistance Program

Job summary

Acuity Insurance is seeking a Workers' Compensation Claims Representative to investigate, evaluate, direct, and control claims across multiple jurisdictions. You will deliver superior customer service to policyholders and agents while handling complex issues with professionalism.

Minimum 2–3 years of workers' compensation claim experience and a college degree are preferred. The role requires solid reading of medical reports, understanding WC statutes, strong communication, and independent claim

Qualifications

• Strong customer service mindset with focus on policyholders and agents.
• Excellent written and verbal communication skills.
• Knowledge of WC statutes and case law.
• Ability to read and evaluate medical reports and determine treatment plans.

Responsibilities

• Investigates coverage, compensability, subrogation, and fraud.
• Reads medical reports to determine injury extent and treatment.
• Provides superior service to policyholders and agents.
• Maintains thorough file documentation and calendar management.
• Conducts claim reviews and presentations to agents and insureds.

Skills

Customer service

Communication skills

Medical terminology

Research

Computing / tech savviness

Education

College degree

Job description

Acuity is seeking a Workers' Compensation Claims Representative to investigate, evaluate, direct, and control Workers’ Compensation claims from multiple jurisdictions. In this role, you will provide superior customer service to our policyholders and agents.

ESSENTIAL RESPONSIBILITIES

• Understands and consistently applies customer service concepts and requirements.
• Conducts thorough initial investigations to determine coverage, compensability, subrogation, and fraud.
• Understands basic anatomy and medical terminology. Able to read and evaluate medical reports to determine extent of injury and treatment plans. Able to recognize, research, and analyze complex medical issues.
• Implements pro‑active direction and control with timely intervention and action planning.
• Understands basic reserving concepts and adheres to company reserving guidelines.
• Effectively utilizes managed care cost containment programs, services, and vendors. Consistently provides direction to assure control of costs.
• Recognizes and aggressively pursues all potential subrogation recovery opportunities.
• Understands and consistently applies legal and statutory concepts of the applicable jurisdiction.
• Provides consistent meaningful file documentation with effective use of the queue and calendar system.
• Demonstrates superior communication skills in all aspects of the position. Places emphasis on meaningful correspondence and effective customer service interactions.
• Conducts Claim Reviews independently with Insureds and Agents.
• Demonstrate interest and ability to handle increasingly more complex issues.
• Maintain a positive attitude and exhibit consistent professionalism.
• Demonstrate creativity and independently conduct research.
• Regular and predictable attendance.
• Performs other duties as assigned.

EDUCATION

College degree preferred.

EXPERIENCE

Minimum 2-3 years of experience in handling Workers' Compensation claims preferred.

OTHER QUALIFICATIONS

• Thorough understanding of personal computing, typing skills, technology and use of mobile devices.
• Basic understanding of medical terminology and treatment, physiology, and anatomy.
• Understanding of WC statutes and case law.
• Someone who has demonstrated sustained excellence over a prolonged period of time.
• Excellent written and verbal communication skills.
• Independently conducts claim reviews & service presentations to agents and potential new insureds.
• Independently handles litigated claims including attending prehearings, mediations, and hearings.
• Has served as a mentor for a new employee or willingness to do so by volunteering with job shadowing and training activities.
• Participates in or conducts a training session for unit and/or department.
• Has accompanied SIU on field claim investigations.
• Ability and willingness to provide quality customer service.
• Must be a self-starter, take on and create new opportunities.
• Ability to work both independently and in collaboration with others.
• Proven organizational and time management skills.

*Acuity does not sponsor applicants for U.S. work authorization.*

This job is classified as exempt.

The salary range for this position is $75,000 - $90,000 annually. This salary range is an estimate, and the actual salary will vary based on applicant’s education, experience, knowledge, skills, and abilities.

For this role, Acuity offers a comprehensive benefits package, including a generous 401(k) contribution, medical, dental, vision, life and disability insurance, paid time off, an Employee Assistance Program, and more. A full description of benefits and eligibility will be provided to candidates during the hiring process.

We are an Equal Employment Opportunity employer. Applicants and employees are considered for positions and are evaluated without regard to mental or physical disability, race, color, religion, gender, national origin, age, genetic information, military or veteran status, sexual orientation, marital status or any other protected Federal, State/Province or Local status unrelated to the performance of the work involved.

Acuity will include at least one in-person interview during the hiring process for all positions.

If you have a disability and require reasonable accommodations to apply or during the interview process, including for in-person interviews, please contact our Talent Acquisition team at [e-mail]. Acuity is dedicated to offering reasonable accommodations during our recruitment process for qualified individuals.