WC Claims Representative I

Society Insurance Fond Du Lac , WI 54935

Posted 2 weeks ago

Primary Purpose

With Claims Manager guidance, resolves mildly complex Workers'

Compensation claims by investigating, evaluating, documenting and negotiating

settlements within established standards.

Essential Functions and Responsibilities

(Other duties may be

assigned)

  • Investigates mildly complex workers'

compensation claims by conducting recorded telephone statements of injured

workers, insureds and witnesses and documenting claim files with results.

  • Determines the insurance carrier's liability by

reviewing the facts of the claims, setting claim reserves, calculating and

paying the appropriate benefits.

  • Determines the desirability of obtaining records

review and independent medical examinations (IME) by reviewing the facts of the

claim and posing questions to independent medical personnel and taking the

appropriate action with the results.

  • Promotes early return to work by communicating

and coordinating between involved parties.

  • Resolves disputed claims through Claims Manager

guidance by referring claims to attorneys, analyzing state statutes, evaluating

evidence and developing a claim resolution strategy.

  • Pursues subrogation recoveries through Claims

Manager guidance by reviewing the facts and determining liability with manager

guidance.

  • Communicates decisions on claims by responding

to communications from: managers, injured workers, injured worker's counsel,

insureds, agents, health care providers, state administrators and others in a

timely manner.

  • Determines the need for medical and vocational

management through Claims Manager guidance by reviewing the severity of the

claim, assigning vendors and directing their activities.

  • Keeps current with claims through follow-up

discussions with injured workers and insureds; makes recommendations to manager

regarding reserve changes and future handling of files based on claim facts.

  • Ensures accurate file documentation by complying

with company procedures and state requirements.

Qualifications

To perform this job successfully, an individual must be

able to perform each essential duty satisfactorily. The requirements listed

below are representative of the knowledge, skills, and/or ability required.

Reasonable accommodations may be made to enable individuals with disabilities

to perform the essential functions.

Required:

  • Bachelor's degree in business or related field.

OR
3+ years

of workers' compensation adjusting experience involving the exercise of

discretionary decision-making as determined by Society Insurance.

  • Valid

driver's license and a satisfactory driving record as determined by Society

Insurance.

Preferred:

  • Bachelor's degree with related claims handling

experience.

  • Proficient investigative skills, demonstrated

through experience.

  • Continued education in and/or experience with

medical terminology and workers' compensation laws and procedures.

  • Demonstrated knowledge of general office

equipment (computer, telephone, calculator/adding machine, fax machine,

headsets and copy machines).

Supervisory Responsibilities

  • None.

Working Conditions and Environment

  • Corporate

location, with an office setting, indoor and climate- controlled is typical;

however, outside work is required as well when inspecting losses.

  • Occasional

travel and possible overnight stays may be required; unusual work hours may

also be required.

  • Fast-paced

work environment, requiring speed and accuracy.

Physical Demands

  • Normal lifting (office work) occurs

continuously, light lifting (up to 10 lbs.) occurs frequently and medium

lifting (up to 30 lbs.) occurs occasionally.


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WC Claims Representative I

Society Insurance