Insurance Claims Evaluator

2 weeks ago

Madison, Wisconsin, United States Universities of Wisconsin Full time

About the Universities of Wisconsin

The Universities of Wisconsin represent a distinguished system of public higher education, serving approximately 162,000 students annually and employing around 35,000 faculty and staff across the state.

With 13 institutions throughout Wisconsin, the Universities of Wisconsin stand as a vital academic, cultural, and economic asset for the state, the nation, and the global community.

Mission of the Office of Risk Management

The Office of Risk Management is dedicated to fostering a safe and healthy educational environment for students, faculty, staff, and visitors utilizing the programs and facilities of the UW System. Our mission is pursued through:

  • Proactive loss prevention and environmental management
  • Expert management of property, liability, and workers' compensation claims
  • Protection of UW System assets
  • Conducting risk assessments and developing mitigation strategies

The Office is committed to developing and maintaining emergency management systems, monitoring high-risk areas, providing expert guidance on workers' compensation claims and workplace injuries, and negotiating insurance policies on behalf of the UW System.

Position Overview

Under the close supervision of the lead Senior Examiner and the Risk Manager, this role involves managing a designated segment of university employee workers' compensation claims.

Key Responsibilities

The primary responsibilities include:

  • Receiving and investigating claims to approve, suspend, or deny them in accordance with Wisconsin Statutes, Chapter 102.
  • Issuing timely workers' compensation benefits following a compensability determination and maintaining appropriate case reserves.
  • Interpreting and evaluating medical reports to ascertain benefits.
  • Handling confidential employee data and medical records with discretion.
  • Recommending the use of third-party services, including private investigations and independent medical examinations.
  • Assessing the potential for third-party lawsuits and informing all parties of the state's subrogation interests.
  • Assisting campuses in creating early return-to-work programs aimed at restoring injured workers to their pre-injury health and employment status.
  • Processing medical bills when appropriate and authorizing payments for bill reviews.

Minimum Qualifications

While experience in workers' compensation is advantageous, entry-level candidates are encouraged to apply as on-the-job training will be provided. Candidates must possess:

  • Strong written and verbal communication skills
  • Proficiency in Microsoft Office Suite
  • Exceptional customer service abilities
  • Analytical skills to assess complex problems and make independent decisions

Preferred Qualifications

Ideal candidates will have substantial experience in one or more of the following areas:

  • Claims management
  • Basic knowledge of medical terminology
  • Understanding of relevant workers' compensation laws and return-to-work programs

Commitment to Inclusive Excellence

Inclusive Excellence is a core value at the Universities of Wisconsin, fostering strength, creativity, and innovation. We appreciate the contributions of every individual and recognize how their diverse identities, cultures, backgrounds, experiences, and perspectives enrich our community. We are dedicated to achieving excellence in teaching, research, community service, and diversity as interconnected goals.

The Universities of Wisconsin strive to create a welcoming and inclusive environment for individuals from all backgrounds, serving the State of Wisconsin and the public good.

Conditions of Employment

All candidates will undergo a criminal background and sexual harassment check prior to employment.

Successful applicants must ensure their eligibility to work in the United States on or before the effective date of appointment.

Work Location

Limited telecommuting or hybrid work options may be available after a satisfactory probationary period. Preference will be given to candidates residing within the state.

Compensation and Benefits

This is a full-time, salaried (exempt) limited appointment. Well-qualified candidates can expect a starting annual salary within the range of $50,000 - $62,500, commensurate with education, experience, and qualifications. The Universities of Wisconsin offer an excellent benefits package.

  • Senior Claims Investigator

    6 days ago

    Madison, Wisconsin, United States American Family Insurance Full time

    Job SummaryThis is a senior-level role that involves investigating and managing complex property and casualty claims. The successful candidate will be responsible for determining liability, securing information, reviewing coverages, arranging appraisals, and settling third-party property liability claims.Key ResponsibilitiesInvestigate Claims: Conduct...

  • Complex Claims Investigator

    7 days ago

    Madison, Wisconsin, United States American Family Insurance Full time

    Job SummaryThis is a Senior level role that involves investigating and managing complex property/casualty claims. The successful candidate will be responsible for determining liability, securing information, reviewing coverages, arranging appraisals, and settling third-party property liability claims.Key ResponsibilitiesInvestigation and Analysis: Conduct...

  • Property Field Inspection Claim Specialist

    6 days ago

    Madison, Wisconsin, United States State Farm Mutual Automobile Insurance Company Full time

    About the RoleWe are seeking a highly skilled Property Field Inspection Claim Specialist to join our team at State Farm Mutual Automobile Insurance Company. As a key member of our claims handling team, you will be responsible for handling accidental and weather-related claims for homeowners, commercial properties, and large losses.Key ResponsibilitiesConduct...

  • Property Field Inspection Claims Adjuster

    2 weeks ago

    Madison, Wisconsin, United States State Farm Mutual Automobile Insurance Company Full time

    Job SummaryWe are seeking a highly skilled Property Field Inspection Claims Adjuster to join our team at State Farm Mutual Automobile Insurance Company. As a Property Field Inspection Claims Adjuster, you will be responsible for conducting on-site inspections and assessments of property damages for both residential and commercial claims.Key...

  • Property Field Inspection Claim Specialist

    5 days ago

    Madison, Wisconsin, United States State Farm Mutual Automobile Insurance Company Full time

    About the RoleWe are seeking a highly skilled Property Field Inspection Claim Specialist to join our team at State Farm Mutual Automobile Insurance Company. As a key member of our claims handling team, you will be responsible for handling accidental and weather-related claims for homeowners, commercial properties, and large losses.Key ResponsibilitiesConduct...

  • Property Field Inspection Claim Specialist

    2 weeks ago

    Madison, Wisconsin, United States State Farm Mutual Automobile Insurance Company Full time

    Job SummaryWe are seeking a highly skilled Property Field Inspection Claim Specialist to join our team at State Farm Mutual Automobile Insurance Company. As a key member of our claims handling team, you will be responsible for handling accidental and weather-related claims for homeowners, commercial properties, and large losses.Key ResponsibilitiesConduct...

  • Senior Claims Adjuster

    5 days ago

    Madison, Wisconsin, United States American Family Mutual Insurance Company Full time

    Job SummaryThis is a Senior-level role that involves investigating and managing complex property/casualty claims. The successful candidate will be responsible for determining liability, securing information, reviewing coverages, arranging appraisals, and settling third-party property liability claims.Key ResponsibilitiesInvestigate Claims Origin and Cause:...

  • Property Field Inspection Claim Specialist

    5 days ago

    Madison, Wisconsin, United States State Farm Mutual Automobile Insurance Company Full time

    About the RoleWe are seeking a highly skilled Property Field Inspection Claim Specialist to join our team at State Farm Mutual Automobile Insurance Company. As a key member of our claims handling team, you will be responsible for handling accidental and weather-related claims for homeowners, commercial properties, and large losses.Key ResponsibilitiesConduct...

  • Senior Claims Adjuster

    2 days ago

    Madison, Wisconsin, United States American Family Mutual Insurance Company Full time

    Job SummaryThis is a Senior-level role that involves investigating and managing complex property/casualty claims. The successful candidate will be responsible for determining liability, securing information, reviewing coverages, arranging appraisals, and settling third-party property liability claims.Key ResponsibilitiesInvestigation and Analysis:...

  • Insurance Underwriter Associate

    5 days ago

    Madison, Wisconsin, United States Rural Mutual Insurance Full time

    About the RoleRural Mutual Insurance is seeking a highly skilled Insurance Underwriter Associate to join our team. As an Insurance Underwriter Associate, you will play a critical role in developing a strong understanding of underwriting, marketing, claims, loss control, audit, and other departments that make up an insurance company.Key...

  • Insurance Forms Coordinator

    1 week ago

    Madison, Wisconsin, United States Homesite Insurance Full time

    Forms Analyst Position at Homesite InsuranceThe Forms Analyst at Homesite Insurance will play a crucial role in the creation and enhancement of forms that adhere to state insurance regulations while fulfilling the needs of the Personal Lines Property sector. Reporting directly to the Senior Manager of Policy Forms, this position encompasses essential...

  • Insurance Customer Service Specialist

    1 week ago

    Madison, Wisconsin, United States Michelle Wenzel Allstate Insurance Full time

    Job OverviewAt Michelle Wenzel Allstate Insurance, we pride ourselves on delivering exceptional service to our clients. As a Licensed Insurance Customer Service Representative, you will be instrumental in providing personalized assistance and support to our valued customers.What We OfferCompetitive Hourly Salary with Commission and Bonus PotentialGenerous...

  • Insurance Customer Service Specialist

    2 weeks ago

    Madison, Wisconsin, United States Michelle Wenzel Allstate Insurance Full time

    Job OverviewAt Michelle Wenzel Allstate Insurance, we are a distinguished insurance agency dedicated to delivering exceptional service to our clients. As a **Licensed Insurance Customer Service Representative**, you will be instrumental in providing tailored support and guidance to our valued customers.We pride ourselves on fostering a collaborative and...

  • Claims Processor Associate

    10 hours ago

    Madison, Wisconsin, United States Highmark Health Full time

    Job SummaryThis role is responsible for reviewing, evaluating, and processing claims to ensure accuracy and compliance with organizational policies and procedures. The successful candidate will have strong analytical and problem-solving skills, with the ability to work independently and as part of a team.Key ResponsibilitiesClaims Processing: Receive and...

  • Insurance Customer Care Specialist

    2 weeks ago

    Madison, Wisconsin, United States Michelle Wenzel Allstate Insurance Full time

    Job OverviewAt Michelle Wenzel Allstate Insurance, we are dedicated to delivering exceptional service to our clients. As a Licensed Insurance Customer Service Representative, you will be instrumental in providing personalized support and guidance to our valued customers.We pride ourselves on fostering a collaborative and welcoming environment where every...

  • Claims Resolution Specialist

    7 days ago

    Madison, Wisconsin, United States HomeSafe Alliance Full time

    About the RoleThe Assistant Claims Manager role is a remote opportunity responsible for ensuring the claim settlements meet or exceed customer expectations and comply with regulatory and company standards.**Key Responsibilities:**Manage large claims, catastrophic loss situations, mold, unusual occurrences, inconvenience claims, property damage claims, and...

  • Claim Adjuster

    2 days ago

    Madison, Wisconsin, United States Medica Full time

    Job Summary:Medica is seeking a highly skilled and detail-oriented Claim Adjustment professional to join our team. As a Claim Adjustment, you will play a critical role in ensuring the accuracy and efficiency of our claims processing operations.Key Responsibilities:Process and analyze various types of medical claims, including inpatient and outpatient...

  • Crop Insurance Underwriting Specialist

    2 weeks ago

    Madison, Wisconsin, United States QBE Insurance Group Full time

    Position Overview:Full-timeEmployment Type:EmployeeRole Summary:Join our team and play a crucial role in enhancing the financial stability of our organization by evaluating and underwriting crop insurance policies. This position ensures adherence to the Federal Crop Insurance Program regulations and internal policies related to crop hail and named peril...

  • Compensation Claims Specialist

    1 week ago

    Madison, Wisconsin, United States University of Wisconsin Full time

    POSITION OVERVIEWThe University of Wisconsin system is a distinguished network of public higher education institutions, serving approximately 162,000 students annually and employing around 35,000 faculty and staff across the state.The Office of Risk Management is dedicated to fostering a safe and healthy educational environment for all individuals involved...

  • Claims Management Specialist

    1 week ago

    Madison, Wisconsin, United States Universities of Wisconsin Full time

    About the OrganizationThe Universities of Wisconsin represent a distinguished system of public higher education, serving approximately 162,000 students annually and employing around 35,000 faculty and staff throughout the state.With a network of 13 universities, the Universities of Wisconsin stand as a vital academic, cultural, and economic asset for the...