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

• Investigates Owned Property, Equipment, Builder's Risk, and other assigned claims of simple to moderate complexity.
• Conducts thorough claim and incident investigations.
• Communicates with Safety, Project Managers, field personnel, and internal departments to obtain claim information and supporting documentation.
• Documents and maintains complete and accurate claim files in the Origami Risk Management Information System.
• Establishes timely and adequate reserves according to the organization's reserving philosophy and methodology.
• Evaluates insurance coverage, liability, damages, contractual responsibility, and claim value.
• Reviews insurance policies, contracts, deductibles, coverage provisions, and project documentation.
• Secures reports, claim forms, estimates, invoices, photographs, receipts, and supporting documentation.
• Reviews bills, estimates, invoices, and receipts for accuracy, reasonableness, and relevance.
• Coordinates site inspections when necessary.
• Develops repair, replacement, mitigation, or resolution strategies with internal and external parties.
• Monitors claim activity and follows up to ensure timely resolution.
• Identifies, investigates, and pursues recovery opportunities, including subrogation.
• Maintains follow-up regarding outstanding documentation, payments, reimbursements, and recovery efforts.
• Maintains confidentiality of claim, employee, project, and company information.
• Provides cross-coverage for Workers' Compensation, General Liability, Auto Liability, and Auto Physical Damage claims as necessary.

• Investigate Owned Property, Equipment, Builder's Risk, and other assigned claims of simple to moderate complexity.
• Conduct thorough claim and incident investigations.
• Communicate with Safety, Project Managers, field personnel, and internal departments to obtain claim information and supporting documentation.
• Document and maintain complete and accurate claim files, including associated costs, in the Origami Risk Management Information System.
• Establish timely and adequate reserves according to the organization's reserving philosophy and methodology.
• Evaluate insurance coverage, liability, damages, contractual responsibility, and claim value.
• Review insurance policies, contracts, deductibles, coverage provisions, and project documentation.
• Secure reports, claim forms, estimates, invoices, photographs, receipts, and other supporting documentation.
• Review bills, estimates, invoices, and receipts for accuracy, reasonableness, and relevance.
• Coordinate site inspections when necessary.
• Develop repair, replacement, mitigation, or resolution strategies with internal and external parties.
• Monitor claim activity and follow up to ensure timely resolution.
• Identify, investigate, and pursue recovery opportunities, including subrogation.
• Maintain follow-up regarding documentation, payments, reimbursements, and recovery efforts.
• Apply claims-handling principles when evaluating coverage, liability, damages, and recovery opportunities.
• Maintain confidentiality of claim, employee, project, and company information.
• Provide cross-coverage for Workers' Compensation, General Liability, Auto Liability, and Auto Physical Damage claims as necessary.
• Report to the Claims Manager.

• Investigate and assemble facts, determine policy coverage, evaluate the amount of loss, and analyze legal liability
• Handle multi-line property and casualty claims in an assigned territory, with emphasis on property claims
• Study insurance policies, endorsements, and forms to become familiar with insurance coverage
• Work toward claim resolution
• Attend arbitrations, mediations, depositions, or trials as necessary
• Ensure claims payments are issued in a timely and accurate manner
• Conduct investigations by phone, mail, and on-site visits
• Provide service to agents, insureds, and others throughout the claim lifecycle
• Work under general supervision

Field Claims Representative

• Manage all aspects of indemnity workers’ compensation claims from inception to conclusion within established authority and guidelines
• Manage a caseload of 150 or fewer workers’ compensation files, including complex claims
• Initiate and investigate claims promptly
• Determine claim compensability and administer benefits based on state law and company guidelines
• Manage medical treatment and medical billing, authorizing as appropriate
• Refer cases to outside defense counsel and direct/manage them as appropriate
• Communicate with claimants, providers, and vendors regarding claims issues
• Compute and set reserves within company guidelines
• Settle and finalize claims and obtain designated authority
• Maintain diary systems and document claim files
• Communicate information to clients to resolve claims efficiently, including injury trends and safety concerns
• Involve loss control staff when appropriate
• Conduct file reviews independently
• Adhere to company policies and procedures
• Perform other duties as assigned

Claims Specialist jobs in Wisconsin

Claims Representative – Casualty