Claims Representative II (Workers Compensation)

Department: Claims | Exempt, Full-time | 40 hours/week with flexible scheduling | Remote/hybrid opportunities in CO, GA, IL, IN, IA, MN, TN, TX, WI. While posted at the Claims Representative II level, candidates with senior-level experience are also encouraged to apply.

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. 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.

Responsibilities

• 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.

Requirements

• Bachelor's Degree and 3+ years of claims handling experience OR 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.
• Professional insurance designations highly desirable.

Skills

• Enjoy communicating and building relationships with others.
• Composed, cool under pressure, and able to negotiate without damaging relationships.
• Hold yourself accountable and act in accordance with rules and regulations.
• Enjoy analyzing, investigating, and using facts to make decisions.
• Naturally curious with a desire to know more.
• Apply an investigative approach to identifying facts and evaluating evidence.