Claims Representative II (Workers Compensation)

Job Information

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 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.

What Society Can Offer 

• Comprehensive Benefits Package: Salary with bonus plan; health, dental, life, and vision insurance
• Retirement: Traditional or Roth 401(k) Defined Contribution Plan PLUS Profit-Sharing Plan
• Work-Life Balance: Company-paid holidays; flexible scheduling; PTO; telecommuting options
• Education: Career Coaching; company-paid courses; student loan and tuition reimbursement
• Community: Charitable Match; paid volunteer time; team sponsorships
• Wellness: 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.