Worker's Compensation Claim Representative

FLSA Status: Salary/Exempt

Reports to: Claims Manager

Revision Date: October 2025

At Wisconsin Municipal Mutual Insurance Company (WMMIC), we believe that how we work is just as important as what we do. Our culture is built on trust, respect, and a shared commitment to excellence—both individually and organizationally.

We value each team member as a respected and appreciated contributor. These Individual Values guide how we show up for one another every day:

• Honesty & Integrity
  – Acting with truthfulness and sincerity, even when it's not easy
• Respect in Action
  – Treating others with kindness, courtesy, and a willingness to help
• Dependability
  – Following through on commitments and being someone others can rely on
• Receptive
  – Staying open to new ideas, listening with curiosity, and valuing diverse perspectives

As an organization, we exist to serve our members with excellence and purpose. These Organizational Values unite us in that mission:

• Members First
  – Prioritizing member needs and acting in their best interest
• Accountability
  – Owning our actions and their impact with transparency and trust
• Excellence
  – Taking pride in our work and striving to exceed expectations
• Continuous Improvement
  – Embracing learning, adaptability, and innovation
• Ethical Conduct
  – Committing to honesty, honor, and doing what's right

Position Summary:

The Worker's Compensation Adjuster is responsible for managing the full life cycle of claims, from initial investigation to final settlement ensuring compliance, protecting organizational interests, and supporting injured workers through a challenging time. This position blends investigative rigor, regulatory expertise, and empathetic communication to ensure fair and timely outcomes for all stakeholders.

Key Responsibilities:

Claims Management & Investigation

• Conduct thorough investigations to assess liability and eligibility for workers' compensation claims.
• Oversee claims from initial report through resolution, including complex medical and lost-time cases.
• Ensure timely and accurate authorization of payments and documentation of claim activity.

Compliance & Documentation

• Maintain compliance with federal, state, and municipal regulations, including WI Municipal Law.
• Prepare and submit required reports to regulatory agencies.
• Document procedures and contribute to process improvements and system upgrades.

Stakeholder Communication

• Serve as the primary liaison between claimants, employers, medical providers, attorneys, and vendors.
• Negotiate settlements and facilitate dispute resolution with professionalism and fairness.
• Provide exceptional customer service and support during onboarding and transitional periods.

Technology & Reporting

• Utilize claims management software (Origami, ISO Claim Search) and Microsoft Office Suite to process claims and generate reports.
• Support system enhancements and contribute to the development of operational efficiencies.

Additional Duties

o  Perform all other duties as assigned to support departmental goals and organizational success.

Qualifications & Requirements

Education & Certification

·      Minimum Bachelor's Degree or equivalent work experience of at least 3 years.

• Minimum of 3 years of Workers' Compensation claims experience to include medical only and Medicare, strong background in lost time; familiarity with Wisconsin DWD and Chapter 102 is a must.
• Proficiency in Microsoft Office Suite, Origami Risk, Verisk Claim Search, and other relevant platforms.
• Valid driver's license, active insurance, and reliable transportation.

Knowledge, Skills & Abilities

• Thorough understanding of Workers' Compensation protocols, calculations, and municipal regulations.
• Strong written and verbal communication skills.
• Proficient in project management and analytical problem-solving.
• High attention to detail with ability to maintain confidentiality and manage multiple tasks efficiently.
• Skilled in software applications and accurate data entry.
• Regular and reliable attendance is required.

Physical Demands

The physical demands described below are representative of those required to successfully perform the essential functions of the Claims Adjuster role. Reasonable accommodations may be made to enable individuals with disabilities to perform these functions.

• Regularly required to talk, hear, and sit for extended periods while reviewing claims, speaking with members, and documenting case details.
• Frequent use of computer equipment including keyboard, monitor, mouse, and telephone.
• Occasionally required to lift and/or move items up to 10 pounds, such as files or promotional materials.
• Occasional travel for company business, including member meetings, trainings, and conferences. Travel may involve various modes of transportation (e.g., airplane, train, bus, rental car).Must be able to travel without restrictions.
• Specific vision abilities required include close vision, peripheral vision, depth perception, and the ability to adjust focus.

Work Environment

• Hybrid Work Model: Primarily remote, with residence in Wisconsin required (within reasonable driving distance).
• In-person participation is expected for scheduled office meetings, trainings, and member-related travel.