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. 

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

• →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.

• →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

• 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

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. 

• 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