West Bend Insurance Company

Claims Specialist

• Review, analyze, and investigate P&C insurance claims
• Determine claim validity and ensure accurate and fair settlements
• Examine policy coverage and gather evidence, including statements, reports, and documentation
• Interview claimants and witnesses
• Identify potential fraud or inconsistencies
• Handle low to moderate complexity Personal and Commercial Lines auto, general liability, and property damage claims
• Investigate, evaluate, and resolve claims while delivering outstanding customer service
• Negotiate settlements with insureds, claimants, and attorneys
• Manage active files, ensure accurate reserving, and maintain compliance with audit guidelines

Claims Representative – Casualty

Investigator

• Investigate suspected insurance fraud involving auto, property, casualty, workers’ compensation, and other personal, commercial, and specialty lines of business
• Work independently and collaboratively with internal stakeholders and external partners to evaluate suspicious insurance transactions
• Collect evidence and support fraud detection programs
• Communicate investigative findings to internal and external partners, regulators, and law enforcement
• Identify red flags, gather facts, and document evidence in compliance with company policy and legal requirements
• Review claim files for inconsistencies, late reporting, coverage anomalies, questionable damages, and medical billing issues
• Conduct and lead thorough investigations of suspect, high-exposure, and complex claims and underwriting/policy concerns
• Conduct advanced investigations into organized fraud schemes and develop major cases and potential criminal fraud prosecutions
• Coordinate investigative action plans with claims, underwriting, and legal partners
• Coordinate and manage outside vendor activity related to assigned SIU investigations
• Prepare detailed investigative reports and support referrals to law enforcement, legal action, or state fraud bureaus
• Stay informed on regulations, statutes, internal protocols, and procedures
• Maintain thorough documentation in accordance with SIU operating standards and best practices
• Serve as a subject matter expert for claims and underwriting training on fraud detection, deterrence, prevention, and complex investigations
• Mentor and peer-train SIU team members on investigative strategy and methodology
• Spend at least 50% of working time in the field servicing the assigned territory

Senior Investigator – Special Investigations Unit

Product Manager

• Monitor, evaluate, and report on the assigned line of business for profitability
• Conduct market research and competitor analysis
• Develop and introduce new or enhanced insurance products
• Collaborate with other areas on proposed bureau changes and annual rate review
• Research and develop new forms, proposed form changes, and draft manuscript endorsements
• Provide support and technical training to underwriters and managers/supervisors for new and existing products or forms
• Maintain agents’ manuals and internal commercial enterprise reference manuals
• Provide underwriting requirements for online rating and application submission systems
• Assist with reinsurance questions and implement changes resulting from revisions in reinsurance contracts
• Collaborate on team-level training needs and research and prepare technical articles and training materials
• Work independently and assist or lead other departmental projects
• Answer coverage questions and report quarterly on data analysis and market trends

Supervisor

• Supervise the activities of contact center associates within the Service Center division
• Select, train, and manage associate performance, including salary and bonus adjustments, performance appraisals, and promotions
• Plan and monitor workflow of the assigned area
• Audit interactions for low-effort experiences, quality customer service, and compliance within the letter of authority
• Monitor and maintain relationships with third-party vendors to ensure quality of service
• Support company-wide initiatives and change management for current and future products and services
• Handle complaints from agents and monitor customer feedback
• Handle escalated issues from staff
• Ensure day-to-day operations run smoothly while driving performance, consistency, and strong customer experience

Service Center Supervisor

• Investigate suspected insurance fraud involving auto, property, casualty, workers’ compensation, and other personal, commercial, and specialty lines
• Collaborate with internal stakeholders and external partners to evaluate suspicious insurance transactions
• Collect evidence and support fraud detection programs
• Communicate investigative findings to internal and external partners, regulators, and law enforcement
• Identify red flags, gather facts, and document evidence in compliance with company policy and legal requirements
• Review claim files for inconsistencies, late reporting, coverage anomalies, questionable damages, and medical billing issues
• Apply checklists, referral criteria, and scoring tools to determine whether further investigation is warranted
• Conduct moderate- to high-complexity investigations with minimal supervision using field, desktop, or combined methods
• Evaluate, coordinate, and recommend investigative action plans with claims, underwriting, and legal partners
• Coordinate and monitor outside vendor activity for assigned SIU investigations
• Prepare detailed investigative reports and support referrals to law enforcement, legal action, or state fraud bureaus when necessary
• Stay informed about regulations, statutes, internal protocols, and procedures
• Maintain documentation of investigative actions and work products according to SIU standards and best practices
• Serve as a subject matter expert for claims and underwriting training on fraud detection, deterrence, and prevention

• Handle complex bodily injury claims with minimal supervision and guidance from the manager
• Lead high-exposure bodily injury claims
• Guide investigations
• Evaluate coverage, liability, and damages
• Negotiate fair settlements and resolutions
• Manage litigated files
• Maintain reserves
• Present select claims to committee
• Serve as a trusted resource and mentor to teammates
• Utilize current Claims technology

Claims Representative – Casualty

Senior Investigator – Special Investigations Unit

Product Manager

Service Center Supervisor

Senior Investigator – Special Investigations Unit

Senior Claims Representative