Claims Representative II

The Claims Representative II investigates, evaluates and resolves assigned claims in a timely and accurate manner in order to achieve a best practices type settlement within legal statutes, policy provisions and Company standards of performance.

This is a hybrid role reporting to the Waukesha, WI office.

POSITION COMPETENCIES

- Business Acumen
- Negotiation
- Results Oriented
- Time & Priority Management
- Decision Making

ESSENTIAL DUTIES AND RESPONSIBILITIES

- Prepares claim file documentation accurately and completely, to include all relevant oral and written statements, photos, facts and environmental factors present at the scene of the accident.
- Makes appropriate contacts and negotiating with policyholders, claimants, third parties, medical and legal professionals in the processes of arbitration, litigation, subrogation, contribution and salvage.
- Achieves a best practices type settlement in the disposition of assigned claims, including assessing all costs and determining first and third party liabilities associated with the settlement of auto property damage, non-complex workers’ compensation, property losses and simple bodily injury claims.
- Effectively identifies and pursues subrogation and salvage opportunities, when available.
- Performs basic and intermediate claims handling duties on assigned claims in a timely manner.
- Verifies coverage and policy provisions in order to identify the claim’s insurability or compensability.
- Takes responsibility for handling and resolving policyholder/self-insured/claimant problems or requests.
- Analyzes and resolves coverage and liability issues or questions.
- Gathers and evaluates factual information that enhances identification of underlying problems or opportunities pertaining to assigned claims.
- Setting or adjusting reserves in accordance with the degree of liability and value of the claim.

ADDITIONAL RESPONSIBILITIES

- At the direction of the Team Leader, may perform limited field work, limited claim handling on workers’ compensation lost time claims of low exposure/low complexity, as well as low exposure/low complexity bodily injury liability claims.
- Generates alternative solutions to problems or situations involving assigned claims.
- Performs other duties as may be assigned by the CSO Team Leader Multi/WC Claims Service Office Manager II, or CSO Team Leader

SPECIAL RELATIONSHIPS

- The Claims Representative II has direct contact and interacts with all levels of personnel within the Claims Service Office
- Interacts with underwriting personnel regarding claim issues
- Interact with agents
- Has direct contact with policyholders/claimants, third parties, medical/legal professionals, vendors

QUALIFICATIONS

Education/Credentials

- Bachelor's degree preferred
- Adjuster’s license or be willing to obtain one as required

Experience

- Successful completion of Claims Representative II Trainee curriculum or a minimum of 1 year experience in a property/casualty claims handling position.
- Experience in a customer service oriented position preferred.

Technical/Professional Knowledge

- Effective communication skills, both oral and written
- Effective inter-personal skills
- Effective organization skills, with the ability to work independently
- Must be detail oriented, as assigned work requires significant attention to detail
- Personal Computer skills, with an emphasis on Microsoft products
- Ability to work within a team-oriented, fast-paced, customer-focused environment
- Basic understanding of tort and state laws applicable to assigned claims
- Basic understanding of the Unfair Claims Settlement Practices Act, insurance policy coverages and provisions, and medical, legal, automotive and construction terminology

The compensation has been carefully determined by considering a variety of important factors, including skill sets, experience, training, and certifications. With these considerations in mind, the estimated hiring range is $52,000 - $72,000. Additionally, you may be able to participate in our annual incentive program, depending on eligibility under the plan.

JOB REQUIREMENTS (as required by ADA – Americans with Disabilities Act)

- This position is primarily a sedentary position that requires occasional standing and walking throughout the office environment.
- Must be able to perform computer-based tasks and access digital information necessary for job duties, including through the use of assistive technologies.
- Must be able to complete computer-based tasks and utilize office equipment as needed to perform essential job functions.
- Must be able to access and enter information accurately using automated systems.
- Must be able to communicate effectively with internal and external clients using telephone, electronic, or other communication systems.
- Must be able to present information to individuals and groups.
- Must be able to interpret and apply concepts that may or may not be based upon established guidelines.
- Must be able to maintain acceptable attendance and adhere to scheduled work hours.
- Must be dependable and able to adhere to scheduled work hours