Position Title: Claims Representative
Reports To: Insurance Services Operations Manager
Department: Insurance Services
FSLA Status: Exempt
Union Status: Non Union
At WEA Member Benefits, we are dedicated to serving our members with highly rated retirement savings, financial planning, and personal insurance programs for public school employees. Our employees have a passion for our mission and vision and strive to deliver “A+ Performance” in everything we do.
WEA Member Benefits was created by Wisconsin educators for Wisconsin educators over 50 years ago. Our culture, work environment, and team have made our organization a 3-time “Best Places To Work” winner (Madison Magazine) and 2-time Top Workplaces winner (Wisconsin State Journal). We focus heavily on taking care of our employees with competitive pay, generous health/dental/vision insurance coverage, paid time off, and an industry leading 401(k) retirement savings plan.
As a member of the WEA Member Benefits (Member Benefits) professional claims handling team, the Claims Representative is responsible for ensuring that all participants and claimants are treated with dignity and respect during all contact with Member Benefits, including during the property and casualty claims adjudication process through clear, concise communication from the date of a loss through its final outcome and by fair, prompt, and accurate adjudicating of property and casualty claims. The Claims Representative must have thorough knowledge of the auto and home policies and must understand the claims process and related procedures.
75% — Claims Adjudication
- The Claims Representative provides quality and timely service to all members, takes accurate and complete auto and home loss notices, explains the claims process to participants and claimants, and completely and accurately documents loss reports.
- Take accurate and complete auto and home loss notices and document loss reports.
- Explain the claims process to participants and claimants.
- Manage independent adjuster assignments.
- Investigate and process first and third-party auto claims by investigating all the circumstances of the loss, interviewing all appropriate parties, reviewing police reports, physical damage assessments, body shop estimates, medical records and medical billings, and assessing liability and damage based on the available information.
- Negotiate and approve auto claims settlements in accordance with established claims procedures and guidelines; and has the authority to issue expense and indemnity payments within established authority limits as described in the Claims Procedures.
- Settle homeowner claims at the discretion of and under the supervision of the Insurance Services Operations Manager as needed.
25% — Quality and Timely Service
- Provide quality and timely service to all members.
- Properly respond to inquiries and complaints from individuals or their representatives by meeting with them, through telephone contact, and/or by providing them with written, accurate investigation report documentation and other information as necessary.
- Inform claimants of the status of their claims, keeps them informed of the claims process, and communicates claims settlements. (25%)
10% – Special Projects
- Perform special projects and duties as needed.
Required Experience and Knowledge
- High School Diploma or equivalent.
- Two (2) to Three (3) years of customer service experience including one (1) year of claims processing experience.
- Commitment to excellence in customer service.
- Experience understanding and interpreting policy terms and their application to actual circumstances.
- Excellent knowledge of the auto and home policies and the related claims processing.
- Excellent verbal communication skills, including the ability to listen effectively and communicate sensitively; determine and ask understandable questions to obtain additional information; appropriately explain the claims process and accurately answer questions.
- Written communication skills, including the ability to compose clear, concise, and persuasive correspondence and narrative reports that communicate messages consistent with Member Benefits’ policies, plans, and provisions while using appropriate spelling, tone, grammar, and word usage.
- Able to accurately perform basic mathematical calculations.
- Able to use word processing software (Microsoft Word and Excel are preferred) and related applicable software.
- Able to effectively organize and prioritize work.
- Able to work cooperatively with others to develop and implement solutions that achieve mutually desired results and to work as a constructive member of a team.
- Able to quickly, effectively, and continually adapt to changes in work objectives, processes, and technology.
Preferred Experience, Knowledge, Abilities
- Associate in Claims (AIC) designation or ability to obtain within five (5) years of hire.
Physical Demands and Work Environment
These physical demands are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable an individual with disabilities to perform the essential job responsibilities.
- Work is primarily performed in an office environment with minimal exposure to injury.
- Must be able to lift and move up to 20 pounds.
- Ongoing daily use of computers and telephone.
- Walk, sit, stand, bend, climb, and use hands to finger, handle, or feel objects, tools or controls; reach with hands and arms; balance; stoop; talk, hear, read, count, and write.
- Specific vision abilities required by the job include close vision, distance vision, color vision, peripheral vision, depth perception, and the ability to focus.
- Must be able to work with frequent interruption.
- Low to moderate noise level.
Note: The purpose of this document is to describe the general nature and level of work performed by personnel so classified; it is not intended to serve as an inclusive list of all responsibilities associated with this position.
To apply for this position, please send your cover letter and resume as well as the completed employee application to email@example.com.
Print, sign, and scan your application document and attach it to the email with your resume. OR mail your employee application separately to:
The Employer Group
c/o Mike Beringer
1000 Solar Ct.
Verona, WI 53593