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Claim specialist jobs in Wisconsin - 104 jobs

  • Workers' Compensation Claims Specialist (REMOTE - IA, MN, NE, WI)

    Holmes Murphy 4.1company rating

    Claim specialist job in Wisconsin

    We are looking to add a Workers' Compensation Claims Specialist to join our Creative Risk Solutions team. The ideal candidate will have jurisdictional experience in Iowa, Minnesota, Nebraska, and Wisconsin. Offering a forward-thinking, innovative, and vibrant company culture, along with the opportunity to share your unique potential, there really is no place like Holmes! Essential Responsibilities: · Receives, gathers and accurately transmits workers' compensation information to the company, from communications with the insured, claimants, and internal staff in a timely manner. · Investigates, evaluates, and resolves lost time Workers' Compensation claims, including litigated claims. · Mediates situations as they arise between the insured and the insurance company, with little to no support from leader, to include researching coverage issues. · Enters and maintains accurate information on a computer system during the claim process, to include final settlement information. · Generates checks for indemnity and medical payments daily. · Develops and monitors consistency in procedural matters of claims handling process within CRS. · Willingness to become licensed if required in jurisdiction where claims are handled. Qualifications: · Education: High school diploma; college degree preferred. Technical designations encouraged, such as AIC and CPCU. · Experience: 3-5 years claims experience with strong background in Workers' Compensation claims handling. · Licensing: Active state specific Workers Compensation License required or the ability to acquire license within three months of hire. Jurisdictional expertise and required licensing in Iowa, Nebraska, Wisconsin, and Minnesota. · Skills: An ideal candidate will have proficient knowledge of Workers' Compensation insurance coverage and claims processing procedures. They will possess the ability to adjudicate lost time claims across multiple jurisdictions and demonstrate the capacity to quickly learn and adapt to various software programs. · Technical Competencies: An ideal candidate will have a strong grasp of claims principles, practices, and insurance coverage interpretation, contributing to workflows and adhering to compliance requirements. They will prioritize problem-solving, actively foster relationships, and collaborate to deliver impactful solutions and a world-class client experience. Here's a little bit about us: Creative Risk Solutions is a leading provider of innovative risk management solutions. We specialize in delivering customized claims management, loss control, and risk consulting services to our clients. Our team is dedicated to excellence, integrity, and creating value for our clients through proactive risk management strategies. In addition to being great at what you do, we place a high emphasis on building a best-in-class culture. We do this through empowering employees to build trust through honest and caring actions, ensuring clear and constructive communication, establishing meaningful client relationships that support their unique potential, and contributing to the organization's success by effectively influencing and uplifting team members. Benefits: In addition to core benefits like health, dental and vision, also enjoy benefits such as: · Paid Parental Leave and supportive New Parent Benefits - We know being a working parent is hard, and we want to support our employees in this journey! · Company paid continuing Education & Tuition Reimbursement - We support those who want to develop and grow. · 401k Profit Sharing - Each year, Holmes Murphy makes a lump sum contribution to every full-time employee's 401k. This means, even if you're not in a position to set money aside for the future at any point in time, Holmes Murphy will do it on your behalf! We are forward-thinking and want to be sure your future is cared for. · Generous time off practices in addition to paid holidays - Yes, we actually encourage employees to use their time off, and they do. After all, you can't be at your best for our clients if you're not at your best for yourself first. · Supportive of community efforts with paid Volunteer time off and employee matching gifts to charities that are important to you - Through our Holmes Murphy Foundation, we offer several vehicles where you can make an impact and care for those around you. · DE&I programs - Holmes Murphy is committed to celebrating every employee's unique diversity, equity, and inclusion (DE&I) experience with us. Not only do we offer all employees a paid Diversity Day time off option, but we also have a Chief Diversity Officer on hand, as well as a DE&I project team, committee, and interest group. You will have the opportunity to take part in those if you wish! · Consistent merit increase and promotion opportunities - Annually, employees are reviewed for merit increases and promotion opportunities because we believe growth is important - not only with your financial wellbeing, but also your career wellbeing. · Discretionary bonus opportunity - Yes, there is an annual opportunity to make more money. Who doesn't love that?! Holmes Murphy & Associates is an Equal Opportunity Employer. #LI-SM1
    $70k-97k yearly est. Auto-Apply 34d ago
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  • Workers' Compensation Claims Specialist (Remote - MN, SD, WI, PA, IA)

    HMA Group Holdings 3.7company rating

    Claim specialist job in Wisconsin

    Creative Risk Solutions (CRS), a proud line of business under the Holmes Murphy umbrella, is a leading Third-Party Administrator (TPA) specializing in innovative claims management solutions. At CRS, we believe in doing things differently-empowering our team to deliver exceptional service, embrace creativity, and make a real impact for our clients. We are looking to add a Workers' Compensation Claims Specialist to join our team. Experience handling claims in Minnesota, South Dakota, Wisconsin, Pennsylvania, and Iowa is preferred. Essential Responsibilities: Receives, gathers and accurately transmits workers' compensation information to the company, from communications with the insured, claimants, and internal staff in a timely manner. Investigates, evaluates, and resolves Workers' Compensation claims. Mediates situations as they arise between the insured and the insurance company, with some support from leader as needed, to include researching coverage issues. Enters and maintains accurate information on a computer system during the claim process, to include final settlement information. Generates checks for indemnity and medical payments daily. Develops and monitors consistency in procedural matters of the claims handling process with CRS. Compiles and interprets Workers' compensation reports on designated accounts, as requested. Ability to adjudicate lost time claims. Participates in claim reviews and attends Risk Control Workshops when requested by agency partners or insureds. These could be in person or by phone. Performs special projects and other duties as requested. Qualifications: Education: High school diploma; college degree preferred. Technical designations encouraged, such as AIC and CPCU. Licensing: Active state specific Workers Compensation License required or the ability to acquire license within three months of hire. Willingness and ability to obtain additional state specific licenses during duration of employment as needed. Experience: 2-4 years claims experience with strong background in Workers' Compensation coverage. Technical Competencies: Invests in the understanding and application of claims principles and practices and insurance coverage interpretation as it relates to consulting, evaluating, and resolving claims. Invests in the understanding and application of claims principles and practices and insurance coverage interpretation as it relates to consulting, evaluating, and resolving claims. Here's a little bit about us: At Creative Risk Solutions, you'll be part of a collaborative, innovative team that values trust, communication, and client focus. We offer competitive compensation, comprehensive benefits, and opportunities for professional growth within the Holmes Murphy family. Benefits: In addition to core benefits like health, dental and vision, also enjoy benefits such as: Paid Parental Leave and supportive New Parent Benefits - We know being a working parent is hard, and we want to support our employees in this journey! Company paid continuing Education & Tuition Reimbursement - We support those who want to develop and grow. 401k Profit Sharing - Each year, Holmes Murphy makes a lump sum contribution to every full-time employee's 401k. This means, even if you're not in a position to set money aside for the future at any point in time, Holmes Murphy will do it on your behalf! We are forward-thinking and want to be sure your future is cared for. Generous time off practices in addition to paid holidays - Yes, we actually encourage employees to use their time off, and they do. After all, you can't be at your best for our clients if you're not at your best for yourself first. Supportive of community efforts with paid Volunteer time off and employee matching gifts to charities that are important to you - Through our Holmes Murphy Foundation, we offer several vehicles where you can make an impact and care for those around you. DE&I programs - Holmes Murphy is committed to celebrating every employee's unique diversity, equity, and inclusion (DE&I) experience with us. Not only do we offer all employees a paid Diversity Day time off option, but we also have a Chief Diversity Officer on hand, as well as a DE&I project team, committee, and interest group. You will have the opportunity to take part in those if you wish! Consistent merit increase and promotion opportunities - Annually, employees are reviewed for merit increases and promotion opportunities because we believe growth is important - not only with your financial wellbeing, but also your career wellbeing. Discretionary bonus opportunity - Yes, there is an annual opportunity to make more money. Who doesn't love that?! The salary range for this role is $45,800- $78,800. Compensation is based on several factors, including, but not limited to, education, work experience and industry certifications. In addition to your salary, Holmes Murphy offers a comprehensive total rewards program including annual bonuses, total wellbeing benefits and support for professional development. Holmes Murphy & Associates is an Equal Opportunity Employer. #LI-SM1
    $45.8k-78.8k yearly Auto-Apply 33d ago
  • Associate Claims Specialist - Workers Compensation - Central Region

    Liberty Mutual 4.5company rating

    Claim specialist job in Wisconsin Dells, WI

    Are you looking for an opportunity to join a fast-growing company that consistently outpaces the industry in year-over-year growth? Liberty Mutual offers exciting openings for Workers Compensation Claims Specialists within the Central Region! As a Workers Compensation Claims Specialist, the successful candidate will join a dedicated Claims Team, utilizing the latest technology to manage a caseload of routine to moderately complex claims. Responsibilities include investigating claims, assessing liability and compensability, evaluating losses, and negotiating settlements. The role involves interactions with claimants, policyholders, appraisers, attorneys, and other third parties throughout the claims management process. The position offers training developed with an emphasis on enhancing skills needed to help provide exceptional service to our customers. Training is a critical component of your success, and that success starts with reliable attendance. Attendance and active engagement during training are mandatory. Training will require 1 week in our Plano, TX office onsite in February 2026. This position may be filled as a Workers Compensation Associate Claims Specialist, Workers Compensation Claims Specialist I, or a Workers Compensation Claims Specialist II. The salary range posted reflects the range for the varying pay scale across various locations. To be considered for this position, candidates must reside within 50 miles of Hoffman Estates, IL, or Indianapolis, IN, and will be required to work in the office twice a month. Candidates located in Ohio, Montana, and Virginia are eligible for 100% remote work, as we do not have claims offices in these states. Please note that this policy is subject to change. Responsibilities * Manages an inventory of claims to evaluate compensability/liability. * Establishes action plan based on case facts, best practices, protocols, regulatory issues and available resources. * Plans and conducts investigations of claims to confirm coverage and to determine liability, compensability and damages. * Assesses policy coverage for submitted claims and notifies the insured of any issues; determines and establishes reserve requirements, adjusting reserves, as necessary, during the processing of the claim, refers claims to the subrogation group or Special Investigations Unit as appropriate. * Evaluates actual damages associated with claims and conducts negotiations, within assigned authority limits, to settle claims. * Performs other duties as assigned. Qualifications * Effective interpersonal, analytical and negotiation abilities required * Ability to provide information in a clear, concise manner with an appropriate level of detail * Demonstrated ability to build and maintain effective relationships * Demonstrated success in a professional environment; success in a customer service/retail environment preferred * Effective analytical skills to gather information, analyze facts, and draw conclusions; as normally acquired through a bachelor's degree or equivalent * Knowledge of legal liability, insurance coverage and medical terminology helpful, but not mandatory * Licensing may be required in some states About Us Pay Philosophy: The typical starting salary range for this role is determined by a number of factors including skills, experience, education, certifications and location. The full salary range for this role reflects the competitive labor market value for all employees in these positions across the national market and provides an opportunity to progress as employees grow and develop within the role. Some roles at Liberty Mutual have a corresponding compensation plan which may include commission and/or bonus earnings at rates that vary based on multiple factors set forth in the compensation plan for the role. At Liberty Mutual, our goal is to create a workplace where everyone feels valued, supported, and can thrive. We build an environment that welcomes a wide range of perspectives and experiences, with inclusion embedded in every aspect of our culture and reflected in everyday interactions. This comes to life through comprehensive benefits, workplace flexibility, professional development opportunities, and a host of opportunities provided through our Employee Resource Groups. Each employee plays a role in creating our inclusive culture, which supports every individual to do their best work. Together, we cultivate a community where everyone can make a meaningful impact for our business, our customers, and the communities we serve. We value your hard work, integrity and commitment to make things better, and we put people first by offering you benefits that support your life and well-being. To learn more about our benefit offerings please visit: *********************** Liberty Mutual is an equal opportunity employer. We will not tolerate discrimination on the basis of race, color, national origin, sex, sexual orientation, gender identity, religion, age, disability, veteran's status, pregnancy, genetic information or on any basis prohibited by federal, state or local law. Fair Chance Notices * California * Los Angeles Incorporated * Los Angeles Unincorporated * Philadelphia * San Francisco
    $60k-82k yearly est. Auto-Apply 16d ago
  • Claims Specialist

    Group Health Cooperative of South Central Wisconsin 3.2company rating

    Claim specialist job in Madison, WI

    This is a full-time hybrid role (40 hours per week). Candidates must be residents of Wisconsin. The Claims Specialist ensures the accurate entry of inpatient and outpatient claims per the data entry guidelines and ensures the timely processing of claims per the adjudication rules for accurate payment or denial. They are also responsible for the accurate use of referral guidelines and benefit plans. Other duties include filing; assisting outside providers, members, and staff regarding claims related questions or issues; and assisting internal staff on complex claims related questions and problems. The Claims Specialist performs under the general direction, guidance, and supervision of the Claims Supervisor. GHC-SCW is a quality driven cooperative built on collaboration, community involvement, innovation, and belonging. In dedication to the health and well-being of our employees, we offer a comprehensive benefits package that includes health and dental insurance, along with paid short-term disability, long-term disability, and life insurance. Additional benefits include paid parental leave, a flexible spending account, employee assistance programs, tuition reimbursement, pet insurance, eyewear discounts, and more. Check us out by clicking on Many Talents, One Mission! The Benefits of Working at GHC-SCW. Job Specific Minimum Qualifications High school graduate or equivalent required. One (1) to two (2) years' administrative experience in an insurance, healthcare, financial or relevant environment. Previous experience in claims resolution /processing or closely related work in an insurance or healthcare environment is highly desirable. Knowledge of or ability to learn and accurately apply claims processing techniques, procedures and practices in a timely manner required. Ability to develop and maintain a working knowledge of claims adjudication rules, computer functions, usual and customary costs, discounts, rates, capitated payment arrangements, contract deadlines, provider changes and benefit plans required. Knowledge of medical terminology preferred. Knowledge or CPT -4 and ICD -10 coding is desirable. Knowledge of and ability to use computers including billing system software, database, word processing, email, and calendar programs. Experience with EPIC systems is desirable but not required. Good verbal and written communication skills required. Good organizational skills required. Must be detail oriented and work with a high degree of accuracy. Good customer services skills required, including the ability to build and maintain effective working relationships with internal and external customers. Ability to maintain patient confidentiality required. Knowledge of or ability to learn HIPAA requirements. Ability to work independently with general supervision required. Ability to type accurately required. Ability to use a 10-key calculator accurately required. Ability to sit and stand intermittently required. Ability to use a keyboard extensively required. The incumbent knows and abides by all GHC-SCW organizational and departmental policies, sets personal standards and strives for high quality work in completing assignments, performs job duties in a timely manner, and represents the organization in a positive manner. Our Mission Statement: We partner with members and the communities we serve to maximize health and well-being. Our Vision: As a local, not-for-profit, member-owned Cooperative, we are the most trusted resource for lifelong health and well-being in the communities we serve. Our Values: We are a not-for-profit Cooperative We are member-centered We are equitable and inclusive We are quality-driven We are innovative We are community involved We believe: Healthcare is a human right. In treating all people with dignity and respect. There is strength in diversity. Equity celebrates our humanity. We are better together.
    $58k-85k yearly est. 3d ago
  • Claims Specialist

    Evans Transportation Services 4.2company rating

    Claim specialist job in Delafield, WI

    Requirements QUALIFICATIONS AND REQUIREMENTS Associate's or Bachelor's Degree preferred. 1-3 years of experience in transportation, logistics, freight claims, customer service, or a related operational role. Prior experience handling freight claims or working with carriers is preferred but not required. Strong attention to detail and ability to manage multiple claims simultaneously. Excellent written and verbal communication skills, with the ability to professionally interact with customers and carriers. Strong critical thinking, problem-solving, and negotiation skills. Working knowledge of truckload and less-than-truckload transportation is preferred. Proficiency in Microsoft Office Suite (Excel, Outlook, Word); experience with Transportation Management Systems is a plus. High level of organizational skills with the ability to meet deadlines in a fast-paced environment. Ability to read, write, type, and speak English fluently is a requirement of this position. PHYSICAL DEMANDS / WORK ENVIRONMENT While performing the duties of this job, the employee must be able to use a keyboard, calculator, and telephone. Frequent sitting, talking, hearing, and close-vision work are required, with occasional standing and lifting (up to 10 lbs.). Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. Salary Description 60000
    $72k-102k yearly est. 17d ago
  • Claims Examiner

    Harriscomputer

    Claim specialist job in Wisconsin

    Responsibilities & Duties:Claims Processing and Assessment: Evaluate incoming claims to determine eligibility, coverage, and validity. Conduct thorough investigations, including reviewing medical records and other relevant documentation. Analyze policy provisions and contractual agreements to assess claim validity. Utilize claims management systems to document findings and process claims efficiently. Communication and Customer Service: Communicate effectively with policyholders, beneficiaries, and healthcare providers regarding claim status and requirements. Provide timely responses to inquiries and maintain professional and empathetic communication throughout the claims process. Address customer concerns and escalate complex issues to senior claims personnel or management as needed. Compliance and Documentation: Ensure compliance with company policies, procedures, and regulatory requirements. Maintain accurate records and documentation related to claims activities. Follow established guidelines for claims adjudication and payment authorization. Quality Assurance and Improvement: Identify opportunities for process improvement and efficiency within the claims department. Participate in quality assurance initiatives to uphold service standards and improve claim handling practices. Collaborate with team members and management to implement best practices and enhance overall departmental performance. Reporting and Analysis: Generate reports and provide data analysis on claims trends, processing times, and outcomes. Contribute to the development of management reports and presentations regarding claims operations.
    $29k-47k yearly est. Auto-Apply 45d ago
  • Claims Representative - Workers Compensation

    West Bend Mutual Insurance 4.8company rating

    Claim specialist job in Appleton, WI

    Recognized as a Milwaukee Journal Sentinel Top Workplace for 14 consecutive years, including three years of being honored as number one! Join us at West Bend, where we believe that our associates are our greatest asset. We hire talented individuals who are conscientious, dedicated, customer focused, and able to build lasting relationships. We create and maintain an environment where you feel a sense of belonging and appreciation. Your diversity of thought, experience, and knowledge are valued. We're committed to fostering a welcoming culture, offering you opportunities for meaningful work and professional growth. More than a workplace, we celebrate our successes and take pride in serving our communities. Job Summary When employees are injured on the job, they need someone who can guide them through the process with care and expertise. As a Workers' Compensation Claims Representative at West Bend, you'll guide injured employees through the recovery process, ensure fair and timely claim resolution, and help businesses stay compliant. If you thrive on problem-solving, negotiation, and making a real impact, this is your opportunity to lead with confidence. Work Location This position offers a hybrid schedule with three in-office collaboration days for team meetings and other events. In certain cases, highly qualified candidates with strong jurisdictional experience may be considered for a remote arrangement. The internal deadline to apply is 2/3/2026. External applications will be accepted on a rolling basis while the position remains open. Responsibilities & Qualifications As a Claims Representative, you will manage claims of varying complexity using current claim technology and best practices. You will conduct thorough investigations to determine coverage, evaluate damages/benefits, and assess liability/compensability. You will negotiate settlements with insureds, claimants, and attorneys while maintaining proactive file management, accurate reserving, and adherence to audit and regulatory standards. This role collaborates closely with internal partners and external stakeholders, with the scope of responsibility (including field work and regional liaison duties) increasing with experience level. Key Responsibilities * Investigate and resolve claims within assigned authority * Determine coverage, damages, and liability * Negotiate settlements with insureds, claimants, and attorneys * Maintain accurate documentation and reserving * Communicate promptly and professionally with all stakeholders * Collaborate with internal teams and external partners * Adhere to audit and compliance standards * Participate in training and team initiatives Preferred Experience and Skills * Prior experience managing claims at the appropriate level of complexity (from low/moderate to high-exposure/complex) * Proficiency with computers and current claim technology * Interpersonal, oral, and written communication skills with customer-focused professionalism * Negotiation, problem-solving, and conflict resolution skills * Time management and organizational discipline with proactive file handling * Independent decision-making ability (higher levels) and results orientation * Technical expertise in coverage analysis, compensability, and damages evaluation (higher levels) * Prior experience managing claims across multiple jurisdictions (higher levels) with preferred jurisdictions of Minnesota and Iowa Preferred Education and Training * Bachelor's degree in Business, Insurance or related field * Associate in General Insurance (AINS) designation * Associate in Claims (AIC) designation * CPCU coursework or other continuing education * Licensure in jurisdictions where required Salary Statement The salary range for this position is $67,000 - $100,000. The actual base pay offered to the successful candidate will be based on multiple factors, including but not limited to job-related knowledge/skills, experience, business needs, geographical location, and internal equity. Compensation decisions are made by West Bend and are dependent upon the facts and circumstances of each position and candidate. Benefits West Bend offers a comprehensive benefit plan including but not limited to: * Medical & Prescription Insurance * Health Savings Account * Dental Insurance * Vision Insurance * Short and Long Term Disability * Flexible Spending Accounts * Life and Accidental Death & Disability * Accident and Critical Illness Insurance * Employee Assistance Program * 401(k) Plan with Company Match * Pet Insurance * Paid Time Off. Standard first year PTO is 17 days, pro-rated based on month of hire. Enhanced PTO may be available for experienced candidates * Bonus eligible based on performance * West Bend will comply with any applicable state and local laws regarding employee leave benefits, including, but not limited to providing time off pursuant to the Colorado Healthy Families and Workplaces Act for Colorado employees, in accordance with its plans and policies. #LI-LW1 EEO West Bend provides equal employment opportunities to all associates and applicants for employment and prohibits discrimination and harassment of any type without regard to race, color, religion, age, sex, national origin, disability status, genetics, protected veteran status, sexual orientation, gender identity or expression, or any other characteristic protected by federal, state or local laws. This policy applies to all terms and conditions of employment, including recruiting, hiring, placement, and promotion.
    $33k-42k yearly est. Auto-Apply 5d ago
  • PL Claims Examiner

    Jewelers Mutual 3.8company rating

    Claim specialist job in Neenah, WI

    The Personal Lines (PL) Claims Examiner is responsible for handling jewelry losses from our personal lines customers located in the United States and Canada. The causes of loss include, among others, damage, theft, and mysterious disappearance. Why Jewelers Mutual: Since 1913 we've been committed to supporting the Jewelry industry and putting customers at the center of everything we do. With over a century of trusted expertise, we're financially strong, forward-thinking, and driven by curiosity. Guided by our core values of Agility, Accountability, and Relevancy, we lead through innovation. As a technology focused organization, we embrace cutting-edge tools and data-driven insights to continuously improve our products, services, and customer experience. Our mission is to be the industry's most trusted advisor by investing in our people, adopting new technologies, and striving for excellence. We're dedicated to fostering growth through collaboration, powered by bold thinking, teamwork, and the passion of our people. Here, you'll: Move fast and embrace change Always look for better ways Grow, thrive, and help shape what's next Join us and be part of a culture where you can make an impact while building your future. What You'll Do: Provides exceptional service to internal and external customers. Investigates and reviews coverage in conjunction with legal precedence. Evaluates exposure(s) based upon an office or field investigation. Directs the efforts of external claim professionals such as adjusters, SIU investigators, and attorneys during the investigation. Collaborates with jewelers, underwriters, loss prevention and sales staff. Aggressively fights fraud and works with our SIU in compliance with local and state regulations. Establishes and maintains accurate reserves based upon company guidelines. Pays claimant/insured amount due according to settlement agreement and company procedures. Maintains excellent written and verbal correspondence with all parties involved on the claim. Identifies and assists with recovery activities. To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. What You'll Bring: Bachelor's degree from four-year college or university. At least two years of claims adjusting experience preferred. Insurance related education including, but not limited to the completion of at least (2) AIC courses or relevant insurance designations such as CPCU or SCLA is desired. Proficiency in Microsoft suite applications including Word, Excel, Outlook, and PowerPoint desired. Property/casualty insurance background and jewelry industry experience are helpful. Certificates, Licenses, Registrations Maintain all adjuster licensing and continuing education requirements. Physical Requirements Prolonged periods sitting at a desk and working on a computer. Occasionally required to stand; walk; use hands to finger, handle, or touch objects or controls; and talk or hear. What We Offer You: Competitive Compensation & Benefits: Includes performance bonuses, generous paid time off, and a top-tier retirement program with 401(k) matching and additional company contributions. Collaborative Culture: Work alongside talented, passionate peers who value ownership and continuous learning. Community & Giving: Benefit from 50% charitable gift matching and paid volunteer time to support nonprofit causes Great Place to Work Certified: Join a team recognized for an environment of innovation and growth. Accessibility and Accommodations We are committed to providing an inclusive and accessible recruitment process. If you require accommodation at any stage of the application or interview process, please let us know by contacting *************************.
    $43k-57k yearly est. 40d ago
  • Pre-Certification Specialist

    Bone and Joint Center, S.C 4.1company rating

    Claim specialist job in Wausau, WI

    We are looking to add someone to our team who can work in a fast-paced environment with great customer service, has great attention to detail, and can quickly adapt to change throughout the day. If you have medical insurance and prior authorization experience who promotes positivity, this position is for you. ABOUT BONE & JOINT Bone and Joint has one of the most comprehensive teams of orthopedic, pain management, podiatric, physical and occupational therapy experts in Northcentral Wisconsin. We aren't a division of another corporate healthcare organization; Bone & Joint belongs to us and we have numerous locations throughout Central Wisconsin. Our mission is to be the Best place for patients to receive care, the Best place for employees to work, and the Best place for physicians to practice medicine. A DAY IN THE LIFE OF A PRE-CERTIFICATION SPECIALIST Being a part of the Pre-Certification/Verification of Benefits Team you will complete a variety of tasks each day in a very fast-paced environment. Our Pre-Certification Specialists work with several different departments throughout Bone & Joint. You will work and communicate daily with our Providers, their clinical teams, Ambulatory Surgery Center teams, Registration, coding & billing team, Therapy teams along with outside companies such as Insurance carriers, and other outside hospital systems. Primarily you will be completing insurance prior authorizations via online or over the phone for procedures, surgery, High end imaging, DME, etc. that our ordered by our providers. We also complete verification of benefits for all patients to ensure they have active coverage and a plan that Bone & Joint accepts at our clinics and Walk-in locations. QUALIFICATIONS FOR A PRE-CERTIFICATION SPECIALIST * High school diploma or equivalent * Patience and ability to work with people at all levels, internal and external, required. * Must have great attention to detail. * 1 plus years' experience with online and telephone prior authorizations for services. * Experience and knowledge of all types of insurances (government, commercial, programs, private). WORK SCHEDULE Workdays of a Pre-Certification Specialist are Monday through Friday 8:30AM to 5:00PM with a 30-minute lunch. Additional flexibility may be offered after the training period and based on business needs. READY TO JOIN OUR TEAM? If you think you have what it takes to do this job, then the next step is to fill out our online application. Don't worry, the application is pretty simple as it asks for your resume and to answer some questions to help us get to know you better. We should warn you though, if you are selected to move forward in the hiring process, we will require that you provide us with further details to help us further understand your interest.
    $47k-65k yearly est. 5d ago
  • Medical-Only Claim Representative-Workers' Compensation

    SFM Mutual Insurance Companies 3.9company rating

    Claim specialist job in Brookfield, WI

    Medical Only Claim Representative - Remote - Must live in Wisconsin to be considered SFM - The Work Comp Experts Work somewhere you love SFM is unique in that we are small enough that your voice is heard, but has all the benefits and perks of a larger employer. We value your opinion, help you reach your goals, and make it easy for you to maintain work-life balance. SFM is committed to creating the best work environment and believes that our exceptional and motivated employees are our greatest strength. SFM emphasizes work life balance, and our benefit package is designed to assist you navigate your work-life journey. Our benefits include: Affordable Medical, Dental, Vision Insurance, HSA, FSA Traditional and Roth 401(k) plans with company match Company contributions to help pay off student loans Monthly home internet allowance Free life insurance, STD & LTD Opportunities for annual gainshare bonus Pet insurance Generous PTO 9 paid holidays Paid parental leave Annual company-wide volunteer day Discounts on gym memberships, fitness apps and weight loss programs Adoption financial assistance Visit our careers page to learn more about working at SFM. The role At SFM, the Medical Only Claims Representative investigates workers' compensation claims to assess whether medical treatment for injured workers is compensable. SFM is committed to providing you the training you need to be successful in this role and will help you develop your skills to grow professionally. This position is a great way to jump start your career at SFM and learn the ins-and-outs of claims handling. In this position, you will work with employees, employers, and medical providers to pay medical benefits according to the State's guidelines and SFM's best practices with the goal to provide a successful resolution of a workers' compensation claim. Using your strong communication skills and critical thinking skills, you will focus on delivering excellent customer service to all parties involved in the claims process. Working collaboratively within a multifunctional team is what makes SFM unique and creates a strong team setting. SFM offers a work environment designed to support flexibility and our benefit options are fashioned so you area able to manage your work-life journey and can bring the best version of yourself to work each day!! Applicants must live in Wisconsin to be eligible for this job. What You Will Be Doing Manages medical-only claims files as assigned by setting up new losses, setting future tasks, requesting medical records and itemized statements, making contact with the policyholder and injured worker and entering necessary file comments into the database. Determines and explains coverage. Works with EEs, physicians, nurses, attorneys within a multifunctional team environment. Approves medical bills that correspond with files, which includes verifying adequate reserves, reviewing for compensability and application of any applicable treatment parameters. May negotiate settlements. Identifies subrogation or fraud opportunities and refers claim to SIU department for follow-up. Makes use of company resources to maintain and control costs. Uses foresight and recognizes the need to consult with or transfer claims back to lost time claims representative if claim is expected to exceed reserve limits, involve a claim for indemnity benefits or involve disputes unable to be resolved. Takes advantage of learning opportunities to develop, update and expand skills, knowledge and abilities, and applies learning. Keeps apprised of workers' compensation rules and regulations and company best practices. Regularly interacts with team members, policyholders, agents, legal counsel, physicians, nurses, and injured workers to achieve individual team goals. Maintains appropriate interactions with both internal and external customers Identifies and communicates trending and claims management practices that could impact the team's book of business from both an MO perspective and overall team perspective. Proactively manages claim inventory to ensure all assigned claims are handled to completion in a timely fashion, including follow-up contacts, bill payment, etc., compliant with regulatory requirements What We'll Love About You Associate's degree or two years' business experience, preferably in an insurance environment or medical office. One or more years handling casualty claims, PIP claims or workers' compensation claims, preferred. Ability to maintain confidentiality. Must be detailed oriented. Excellent customer service skills, and the ability to work well within a team environment. Excellent problem solving and decision making skills. Strong verbal and written communication skills. Ability to conduct research, assimilate and interpret complex information from a variety of sources. Ability to work in a fast paced environment and manage multiple projects and deadlines with limited supervision. Effective conflict resolution skills. Basic mathematic skills. Proficient in MS Office software applications (Excel/Word, etc.). Work Environment and Physical Demands Work takes place in a remote semi paperless environment within a home office setting or in-office setting, using standard office equipment such as computers, phones, and photocopiers, which requires being stationary for extended periods of time. While performing the duties of this job, the employee is regularly required to talk or hear, and maintain concentration and focus. The employee frequently is required to stand; walk; use hands and fingers, handle or feel; and reach with hands and arms and work with close vision. This position requires the ability to occasionally lift office products and supplies, up to 20 pounds. Work is performed indoors with little to no exposure to extreme outdoor weather conditions. Regular attendance is required. About SFM Since 1983, our mission has been to be the workers' compensation partner of choice for agents, employers and their workers. In that time, we've expanded to over 25,000 customers in the Midwest and grown our offerings to include vocational rehabilitation, loss prevention, medical services and more. Though much has changed through the years, our focus continues to be unrivaled customer service, safety, and providing better outcomes for employers and injured workers. Join us!! Click Apply Now Watch Videos to learn more about SFM's careers and culture. SFM Mutual Insurance Company and each of its parent companies, subsidiaries and/or affiliated companies are Equal Opportunity/Affirmative Action Employers. SFM provides equal employment opportunities to all employees and applicants for employment and prohibits discrimination and harassment of any type without regard to race, color, religion, age, sex, national origin, disability status, genetics, protected veteran status, status with regard to public assistance, sexual orientation, gender identity or expression, or any other characteristic protected by federal, state or local laws. SFM Companies, EEO/AA Employers. SFM is a participant of E-Verify. Applicants have rights under Federal Employment Laws.
    $30k-37k yearly est. 10d ago
  • Daily Claims Adjuster - Madison, WI Region

    Cenco Claims 3.8company rating

    Claim specialist job in Madison, WI

    CENCO Claims is expanding daily field coverage in southern Wisconsin and is looking for reliable property adjusters to support ongoing claim volume in and around Madison. This is a field-based role designed for adjusters who want consistent daily assignments, clear expectations, and the flexibility to manage their own workload. What You'll Be Doing Complete on-site inspections for property losses related to wind, hail, water, and fire Document findings with clear photos, measurements, and field notes Write accurate estimates using Xactimate or Symbility Communicate professionally with policyholders, contractors, and carrier partners Move claim files forward efficiently while meeting carrier timelines What We're Looking For Active Wisconsin adjuster license Working knowledge of Xactimate or Symbility Reliable transportation, ladder, laptop, and standard field equipment Strong organization and time management skills Ability to accept assignments promptly and submit reports on schedule What CENCO Offers Steady daily claim volume across the Madison market Competitive compensation with dependable payments Organized workflows and responsive internal support Long-term opportunities with a growing regional footprint If you're an adjuster who values consistency, flexibility, and solid back-end support, this is a strong opportunity to stay busy in the Madison area.
    $45k-54k yearly est. Auto-Apply 60d+ ago
  • Adjusted Hours Around Campus | Friday, January 23

    Maranatha Baptist University 3.3company rating

    Claim specialist job in Watertown, WI

    Academic Affairs | Office hours 1:00-3:30 PM | Available by email Alumni Services | Regular office hours Athletics | Regular gym hours | Regular afternoon & evening practices Business Office | Office hours 10:00 AM-3:00 PM CBCM/Seminary Office | Closed | Available by email Cedarholm Library | Closed Department of Humanities | Office closed | Available by email Department of Music | Office closed | Available by email | Steinbart Duo Recital rescheduled | Chambers Singers kick-off at Fellowship Baptist Church on Saturday as scheduled Enrollment Management Office | Regular office hours Financial Aid Office | Office hours 10:00 AM-3:00 PM Hanneman Hall | Closed Human Resources | Office closed | Available by email Information Technology | Help Desk hours 9:30 AM-4:00 PM | Available by email Maranatha Baptist Academy | No classes | Play performance 7 PM as scheduled MBBI | Office closed | Available by email ODL | Regular office hours | Available by email Old Main Café | Closed Pioneer College Caterers | No breakfast (pick up breakfast items on Thursday) | Lunch 11:30 AM-1:15 PM | Dinner 4:30-6:00 PM Post Office/Spirit Shop | Closed Registrar's Office | Office hours 10:30 AM-3:30 PM | Available by email & phone | Drop Add Deadline Friday at 5 PM Science Lab | Closed School of Business | Office closed | Available by email School of Education | Office closed | Available by email School of Nursing | Office closed | Available by email Student Life Office | Regular office hours, dorm lock, and building duties in DC and OM
    $36k-42k yearly est. 9d ago
  • Claims Representative - Workers Compensation

    Thesilverlining

    Claim specialist job in West Bend, WI

    Recognized as a Milwaukee Journal Sentinel Top Workplace for 14 consecutive years, including three years of being honored as number one! Join us at West Bend, where we believe that our associates are our greatest asset. We hire talented individuals who are conscientious, dedicated, customer focused, and able to build lasting relationships. We create and maintain an environment where you feel a sense of belonging and appreciation. Your diversity of thought, experience, and knowledge are valued. We're committed to fostering a welcoming culture, offering you opportunities for meaningful work and professional growth. More than a workplace, we celebrate our successes and take pride in serving our communities. Job Summary When employees are injured on the job, they need someone who can guide them through the process with care and expertise. As a Workers' Compensation Claims Representative at West Bend, you'll guide injured employees through the recovery process, ensure fair and timely claim resolution, and help businesses stay compliant. If you thrive on problem-solving, negotiation, and making a real impact, this is your opportunity to lead with confidence. Work Location This position offers a hybrid schedule with three in-office collaboration days for team meetings and other events. In certain cases, highly qualified candidates with strong jurisdictional experience may be considered for a remote arrangement. The internal deadline to apply is 2/3/2026. External applications will be accepted on a rolling basis while the position remains open. Responsibilities & Qualifications As a Claims Representative, you will manage claims of varying complexity using current claim technology and best practices. You will conduct thorough investigations to determine coverage, evaluate damages/benefits, and assess liability/compensability. You will negotiate settlements with insureds, claimants, and attorneys while maintaining proactive file management, accurate reserving, and adherence to audit and regulatory standards. This role collaborates closely with internal partners and external stakeholders, with the scope of responsibility (including field work and regional liaison duties) increasing with experience level. Key Responsibilities Investigate and resolve claims within assigned authority Determine coverage, damages, and liability Negotiate settlements with insureds, claimants, and attorneys Maintain accurate documentation and reserving Communicate promptly and professionally with all stakeholders Collaborate with internal teams and external partners Adhere to audit and compliance standards Participate in training and team initiatives Preferred Experience and Skills Prior experience managing claims at the appropriate level of complexity (from low/moderate to high-exposure/complex) Proficiency with computers and current claim technology Interpersonal, oral, and written communication skills with customer-focused professionalism Negotiation, problem-solving, and conflict resolution skills Time management and organizational discipline with proactive file handling Independent decision-making ability (higher levels) and results orientation Technical expertise in coverage analysis, compensability, and damages evaluation (higher levels) Prior experience managing claims across multiple jurisdictions (higher levels) with preferred jurisdictions of Minnesota and Iowa Preferred Education and Training Bachelor's degree in Business, Insurance or related field Associate in General Insurance (AINS) designation Associate in Claims (AIC) designation CPCU coursework or other continuing education Licensure in jurisdictions where required Salary Statement The salary range for this position is $67,000 - $100,000. The actual base pay offered to the successful candidate will be based on multiple factors, including but not limited to job-related knowledge/skills, experience, business needs, geographical location, and internal equity. Compensation decisions are made by West Bend and are dependent upon the facts and circumstances of each position and candidate. Benefits West Bend offers a comprehensive benefit plan including but not limited to: Medical & Prescription Insurance Health Savings Account Dental Insurance Vision Insurance Short and Long Term Disability Flexible Spending Accounts Life and Accidental Death & Disability Accident and Critical Illness Insurance Employee Assistance Program 401(k) Plan with Company Match Pet Insurance Paid Time Off. Standard first year PTO is 17 days, pro-rated based on month of hire. Enhanced PTO may be available for experienced candidates Bonus eligible based on performance West Bend will comply with any applicable state and local laws regarding employee leave benefits, including, but not limited to providing time off pursuant to the Colorado Healthy Families and Workplaces Act for Colorado employees, in accordance with its plans and policies. #LI-LW1 EEO West Bend provides equal employment opportunities to all associates and applicants for employment and prohibits discrimination and harassment of any type without regard to race, color, religion, age, sex, national origin, disability status, genetics, protected veteran status, sexual orientation, gender identity or expression, or any other characteristic protected by federal, state or local laws. This policy applies to all terms and conditions of employment, including recruiting, hiring, placement, and promotion.
    $29k-41k yearly est. Auto-Apply 5d ago
  • Benefit Verification Specialist I (Oconomowoc)

    The Rogers Company 4.8company rating

    Claim specialist job in Oconomowoc, WI

    The Benefit Verification Specialist I plays a key role in ensuring that front-end teams coordinating patient care have a clear understanding of each patient's behavioral health insurance benefits prior to treatment. As the first step in the patient's financial experience, this position verifies behavioral health benefits, determines patient financial responsibility, and communicates coverage information effectively to internal teams to support timely and accurate admissions and claims. The specialist is also responsible for identifying and correcting demographic errors daily, ensuring accuracy and compliance for all admitted patients. Job Duties & Responsibilities: Verify behavioral health insurance benefits for patients and potential patients Spend significant time on the phone and online with insurance and managed care companies to confirm behavioral health coverage, limitations, referrals and authorization requirements. Use online payer portals as well as facility resources, managed care grids to accurately receive, interpret, and document benefit information.as required Accurately document quote of benefit details in Cerner, using correct dropdown selections, updating required fields, and assigning items to follow-up worklists as appropriate Maintain high-level multitasking by actively working in multiple systems at once, verifying benefits, completing portal checks, correcting registration or demographic errors, and documenting results in Cerner, all while navigating multiple monitors and continuing productive work during insurance hold times. Audit demographic, insurance and financial data daily to ensure accuracy for encounters. Communicate with admissions, care coordination and utilization review teams to ensure accuracy of accounts Identify potential coverage issues and escalate appropriately to avoid admission delays. Knowledge of Rogers programs and the facility's admission, insurance authorization, and billing processes. Support departmental goals and team development Participate in daily peer audits and huddles, providing and receiving constructive feedback in a professional manner. Maintain up-to-date knowledge of behavioral health payer policies, authorization requirements, and facility programs. Support patients and internal teams by addressing benefit-related questions promptly and accurately. Contribute to training efforts, uphold department policies and procedures, and demonstrate punctuality, professionalism, and teamwork. Apply good practice principles to job duties. Use good communication skills and tact to deal effectively with third-party carrier representatives, and all other team members internally and externally. Use common sense in situations and respond appropriately in all communication modes (body language, verbal) to everyone, regardless of his/her/their behavior. Maintain a calm attitude and create a conducive atmosphere in difficult situations. Work cooperatively and supportively with all Remain courteous and respectful to others during work interactions and be willing to work out problems on a one-on-one basis. Complete assignments and documentation on time. Take responsibility for and manage day-to-day problems, including completion of all documents. Complete other duties as assigned by the supervisor of Benefit Verification team Promote department goals and the Mission of Rogers Behavioral Health. Communicate goals to fellow staff members. Demonstrate measurable goal achievement. Maintain department policies and procedures. Include requirements and guidelines from external agencies (State of Wisconsin, Joint Commission ). Educate new staff regarding regulations or requirements of those functions that relate to their areas or departments, as directed. Demonstrate acceptance and training of student interns in the department, as directed. Demonstrate understanding of Joint Commission and other regulatory agency compliance regulations. Involve self in the learning and application of standards relevant to Admission Services. Participate in in-services, seminars, and other meetings to increase involvement and awareness of regulations. Involve self in the education of other disciplines regarding Admission Services' regulations. Participate in Rogers committees, Rogers Improvement System (RIS) team meetings and team projects, as directed. Demonstrate punctuality and preparedness. Demonstrate effective communication skills and good organizational skills. Contribute in a positive, solution-focused manner. Demonstrate willingness to complete tasks/responsibilities related to projects (i.e., audits, tracking data, etc.).Conduct self in a professional manner. Demonstrate organizational skills that promote timely response to all inquiries and to task completion. Communicate with all individuals in a positive and professional manner. Attempt to resolve individual issues with peers in a positive, calm manner, with a focus on solution. Communicate concerns and provide solutions for same. Attend outside seminars to promote professional growth. Demonstrate a positive and professional attitude toward parties outside Rogers (patient families, visitors, vendors, etc.).Comply with the Hospital's policies and procedures, including Human Resources, Infection Control and Employee Health policies and programs. Project a professional image by wearing appropriate, professional attire. Additional Job Description: Physical/Mental Demands: Ability to be flexible with work assignments, including schedule changes, caseload volume changes, changes in required documentation, program additions, and changes in policy and procedure. Sedentary position Ability to work effectively with professional staff, and Hospital staff members. Ability to exercise good judgment in determining the correct course of action in admission procedures and to utilize independent thinking. Ability to maintain a cooperative, tactful, warm, courteous, and helpful attitude toward, professional staff, and Hospital personnel at all times. Dependability, flexibility, and efficiency, possessing a positive attitude toward work at Rogers Behavioral Health. Computer skills required, including navigating multiple monitors, payer portals, EHR systems (Cerner preferred), Microsoft Office (Outlook, Word, Excel), and real-time documentation tools. High accuracy and attention to detail in data entry, documentation, and interpreting patient financial responsibility (deductibles, copays, coinsurance). Strong communication and problem-solving skills, including professional phone etiquette with payers, clear written documentation, time-management, and critical thinking. Commitment to confidentiality and HIPAA compliance while handling sensitive patient and insurance information. Verbal and hearing ability to interact with third-party payors and employees Numerical ability to maintain records and operate a computer. Ability to read and communicate through written, verbal and auditory skills. Physical and mental ability to perform job duties as verified by a physical exam by a licensed physician, per post-employment physical. Education Knowledge Requirements: High school diploma required. Minimum 1 year of experience in healthcare, insurance, patient access, billing, revenue cycle, or a related administrative role preferred Experience with insurance verification, managed care plans, or behavioral health benefits strongly preferred With a career at Rogers, you can look forward to a Total Rewards package of benefits, including: Health, dental, and vision insurance coverage for you and your family 401(k) retirement plan Employee share program Life/disability insurance Flex spending accounts Tuition reimbursement Health and wellness program Employee assistance program (EAP) Through UnitedHealthcare, UMR and HealthSCOPE Benefits creates and publishes the Machine-Readable Files on behalf of Rogers Behavioral Health. To link to the Machine-Readable Files, please visit Transparency in Coverage (uhc.com)
    $19k-25k yearly est. Auto-Apply 42d ago
  • Workers' Compensation Claims Specialist (Remote - MN, SD, WI, PA, IA)

    Holmes Murphy 4.1company rating

    Claim specialist job in Wisconsin

    Creative Risk Solutions (CRS), a proud line of business under the Holmes Murphy umbrella, is a leading Third-Party Administrator (TPA) specializing in innovative claims management solutions. At CRS, we believe in doing things differently-empowering our team to deliver exceptional service, embrace creativity, and make a real impact for our clients. We are looking to add a Workers' Compensation Claims Specialist to join our team. Experience handling claims in Minnesota, South Dakota, Wisconsin, Pennsylvania, and Iowa is preferred. Essential Responsibilities: Receives, gathers and accurately transmits workers' compensation information to the company, from communications with the insured, claimants, and internal staff in a timely manner. Investigates, evaluates, and resolves Workers' Compensation claims. Mediates situations as they arise between the insured and the insurance company, with some support from leader as needed, to include researching coverage issues. Enters and maintains accurate information on a computer system during the claim process, to include final settlement information. Generates checks for indemnity and medical payments daily. Develops and monitors consistency in procedural matters of the claims handling process with CRS. Compiles and interprets Workers' compensation reports on designated accounts, as requested. Ability to adjudicate lost time claims. Participates in claim reviews and attends Risk Control Workshops when requested by agency partners or insureds. These could be in person or by phone. Performs special projects and other duties as requested. Qualifications: Education: High school diploma; college degree preferred. Technical designations encouraged, such as AIC and CPCU. Licensing: Active state specific Workers Compensation License required or the ability to acquire license within three months of hire. Willingness and ability to obtain additional state specific licenses during duration of employment as needed. Experience: 2-4 years claims experience with strong background in Workers' Compensation coverage. Technical Competencies: Invests in the understanding and application of claims principles and practices and insurance coverage interpretation as it relates to consulting, evaluating, and resolving claims. Invests in the understanding and application of claims principles and practices and insurance coverage interpretation as it relates to consulting, evaluating, and resolving claims. Here's a little bit about us: At Creative Risk Solutions, you'll be part of a collaborative, innovative team that values trust, communication, and client focus. We offer competitive compensation, comprehensive benefits, and opportunities for professional growth within the Holmes Murphy family. Benefits: In addition to core benefits like health, dental and vision, also enjoy benefits such as: Paid Parental Leave and supportive New Parent Benefits - We know being a working parent is hard, and we want to support our employees in this journey! Company paid continuing Education & Tuition Reimbursement - We support those who want to develop and grow. 401k Profit Sharing - Each year, Holmes Murphy makes a lump sum contribution to every full-time employee's 401k. This means, even if you're not in a position to set money aside for the future at any point in time, Holmes Murphy will do it on your behalf! We are forward-thinking and want to be sure your future is cared for. Generous time off practices in addition to paid holidays - Yes, we actually encourage employees to use their time off, and they do. After all, you can't be at your best for our clients if you're not at your best for yourself first. Supportive of community efforts with paid Volunteer time off and employee matching gifts to charities that are important to you - Through our Holmes Murphy Foundation, we offer several vehicles where you can make an impact and care for those around you. DE&I programs - Holmes Murphy is committed to celebrating every employee's unique diversity, equity, and inclusion (DE&I) experience with us. Not only do we offer all employees a paid Diversity Day time off option, but we also have a Chief Diversity Officer on hand, as well as a DE&I project team, committee, and interest group. You will have the opportunity to take part in those if you wish! Consistent merit increase and promotion opportunities - Annually, employees are reviewed for merit increases and promotion opportunities because we believe growth is important - not only with your financial wellbeing, but also your career wellbeing. Discretionary bonus opportunity - Yes, there is an annual opportunity to make more money. Who doesn't love that?! The salary range for this role is $45,800- $78,800. Compensation is based on several factors, including, but not limited to, education, work experience and industry certifications. In addition to your salary, Holmes Murphy offers a comprehensive total rewards program including annual bonuses, total wellbeing benefits and support for professional development. Holmes Murphy & Associates is an Equal Opportunity Employer. #LI-SM1
    $45.8k-78.8k yearly Auto-Apply 33d ago
  • Workers' Compensation Claims Specialist (REMOTE - IA, MN, NE, WI)

    HMA Group Holdings 3.7company rating

    Claim specialist job in Wisconsin

    We are looking to add a Workers' Compensation Claims Specialist to join our Creative Risk Solutions team. The ideal candidate will have jurisdictional experience in Iowa, Minnesota, Nebraska, and Wisconsin. Offering a forward-thinking, innovative, and vibrant company culture, along with the opportunity to share your unique potential, there really is no place like Holmes! Essential Responsibilities: · Receives, gathers and accurately transmits workers' compensation information to the company, from communications with the insured, claimants, and internal staff in a timely manner. · Investigates, evaluates, and resolves lost time Workers' Compensation claims, including litigated claims. · Mediates situations as they arise between the insured and the insurance company, with little to no support from leader, to include researching coverage issues. · Enters and maintains accurate information on a computer system during the claim process, to include final settlement information. · Generates checks for indemnity and medical payments daily. · Develops and monitors consistency in procedural matters of claims handling process within CRS. · Willingness to become licensed if required in jurisdiction where claims are handled. Qualifications: · Education: High school diploma; college degree preferred. Technical designations encouraged, such as AIC and CPCU. · Experience: 3-5 years claims experience with strong background in Workers' Compensation claims handling. · Licensing: Active state specific Workers Compensation License required or the ability to acquire license within three months of hire. Jurisdictional expertise and required licensing in Iowa, Nebraska, Wisconsin, and Minnesota. · Skills: An ideal candidate will have proficient knowledge of Workers' Compensation insurance coverage and claims processing procedures. They will possess the ability to adjudicate lost time claims across multiple jurisdictions and demonstrate the capacity to quickly learn and adapt to various software programs. · Technical Competencies: An ideal candidate will have a strong grasp of claims principles, practices, and insurance coverage interpretation, contributing to workflows and adhering to compliance requirements. They will prioritize problem-solving, actively foster relationships, and collaborate to deliver impactful solutions and a world-class client experience. Here's a little bit about us: Creative Risk Solutions is a leading provider of innovative risk management solutions. We specialize in delivering customized claims management, loss control, and risk consulting services to our clients. Our team is dedicated to excellence, integrity, and creating value for our clients through proactive risk management strategies. In addition to being great at what you do, we place a high emphasis on building a best-in-class culture. We do this through empowering employees to build trust through honest and caring actions, ensuring clear and constructive communication, establishing meaningful client relationships that support their unique potential, and contributing to the organization's success by effectively influencing and uplifting team members. Benefits: In addition to core benefits like health, dental and vision, also enjoy benefits such as: · Paid Parental Leave and supportive New Parent Benefits - We know being a working parent is hard, and we want to support our employees in this journey! · Company paid continuing Education & Tuition Reimbursement - We support those who want to develop and grow. · 401k Profit Sharing - Each year, Holmes Murphy makes a lump sum contribution to every full-time employee's 401k. This means, even if you're not in a position to set money aside for the future at any point in time, Holmes Murphy will do it on your behalf! We are forward-thinking and want to be sure your future is cared for. · Generous time off practices in addition to paid holidays - Yes, we actually encourage employees to use their time off, and they do. After all, you can't be at your best for our clients if you're not at your best for yourself first. · Supportive of community efforts with paid Volunteer time off and employee matching gifts to charities that are important to you - Through our Holmes Murphy Foundation, we offer several vehicles where you can make an impact and care for those around you. · DE&I programs - Holmes Murphy is committed to celebrating every employee's unique diversity, equity, and inclusion (DE&I) experience with us. Not only do we offer all employees a paid Diversity Day time off option, but we also have a Chief Diversity Officer on hand, as well as a DE&I project team, committee, and interest group. You will have the opportunity to take part in those if you wish! · Consistent merit increase and promotion opportunities - Annually, employees are reviewed for merit increases and promotion opportunities because we believe growth is important - not only with your financial wellbeing, but also your career wellbeing. · Discretionary bonus opportunity - Yes, there is an annual opportunity to make more money. Who doesn't love that?! Holmes Murphy & Associates is an Equal Opportunity Employer. #LI-SM1
    $43k-74k yearly est. Auto-Apply 34d ago
  • Associate Claims Specialist - Workers Compensation - Central Region

    Liberty Mutual 4.5company rating

    Claim specialist job in Wisconsin Dells, WI

    Are you looking for an opportunity to join a fast-growing company that consistently outpaces the industry in year-over-year growth? Liberty Mutual offers exciting openings for Workers Compensation Claims Specialists within the Central Region! As a Workers Compensation Claims Specialist, the successful candidate will join a dedicated Claims Team, utilizing the latest technology to manage a caseload of routine to moderately complex claims. Responsibilities include investigating claims, assessing liability and compensability, evaluating losses, and negotiating settlements. The role involves interactions with claimants, policyholders, appraisers, attorneys, and other third parties throughout the claims management process. The position offers training developed with an emphasis on enhancing skills needed to help provide exceptional service to our customers. Training is a critical component of your success, and that success starts with reliable attendance. Attendance and active engagement during training are mandatory. Training will require 1 week in our Plano, TX office onsite in February 2026. This position may be filled as a Workers Compensation Associate Claims Specialist, Workers Compensation Claims Specialist I, or a Workers Compensation Claims Specialist II. The salary range posted reflects the range for the varying pay scale across various locations. To be considered for this position, candidates must reside within 50 miles of Hoffman Estates, IL, or Indianapolis, IN, and will be required to work in the office twice a month. Candidates located in Ohio, Montana, and Virginia are eligible for 100% remote work, as we do not have claims offices in these states. Please note that this policy is subject to change. Responsibilities Manages an inventory of claims to evaluate compensability/liability. Establishes action plan based on case facts, best practices, protocols, regulatory issues and available resources. Plans and conducts investigations of claims to confirm coverage and to determine liability, compensability and damages. Assesses policy coverage for submitted claims and notifies the insured of any issues; determines and establishes reserve requirements, adjusting reserves, as necessary, during the processing of the claim, refers claims to the subrogation group or Special Investigations Unit as appropriate. Evaluates actual damages associated with claims and conducts negotiations, within assigned authority limits, to settle claims. Performs other duties as assigned. Qualifications Effective interpersonal, analytical and negotiation abilities required Ability to provide information in a clear, concise manner with an appropriate level of detail Demonstrated ability to build and maintain effective relationships Demonstrated success in a professional environment; success in a customer service/retail environment preferred Effective analytical skills to gather information, analyze facts, and draw conclusions; as normally acquired through a bachelor's degree or equivalent Knowledge of legal liability, insurance coverage and medical terminology helpful, but not mandatory Licensing may be required in some states About Us Pay Philosophy: The typical starting salary range for this role is determined by a number of factors including skills, experience, education, certifications and location. The full salary range for this role reflects the competitive labor market value for all employees in these positions across the national market and provides an opportunity to progress as employees grow and develop within the role. Some roles at Liberty Mutual have a corresponding compensation plan which may include commission and/or bonus earnings at rates that vary based on multiple factors set forth in the compensation plan for the role. At Liberty Mutual, our goal is to create a workplace where everyone feels valued, supported, and can thrive. We build an environment that welcomes a wide range of perspectives and experiences, with inclusion embedded in every aspect of our culture and reflected in everyday interactions. This comes to life through comprehensive benefits, workplace flexibility, professional development opportunities, and a host of opportunities provided through our Employee Resource Groups. Each employee plays a role in creating our inclusive culture, which supports every individual to do their best work. Together, we cultivate a community where everyone can make a meaningful impact for our business, our customers, and the communities we serve. We value your hard work, integrity and commitment to make things better, and we put people first by offering you benefits that support your life and well-being. To learn more about our benefit offerings please visit: *********************** Liberty Mutual is an equal opportunity employer. We will not tolerate discrimination on the basis of race, color, national origin, sex, sexual orientation, gender identity, religion, age, disability, veteran's status, pregnancy, genetic information or on any basis prohibited by federal, state or local law. Fair Chance Notices California Los Angeles Incorporated Los Angeles Unincorporated Philadelphia San Francisco We can recommend jobs specifically for you! Click here to get started.
    $60k-82k yearly est. Auto-Apply 3d ago
  • Claims Specialist

    Evans Transportation Services, Inc. 4.2company rating

    Claim specialist job in Delafield, WI

    Job DescriptionDescription: Claims Manager has no supervisory responsibilities Department: Client Solutions | Claims FLSA/Pay Status: Non-Exempt - Salary Full Time Updated: January 2026 JOB SUMMARY Under the direction of the Claims Manager, the Claims Specialist is responsible for the day-to-day execution of freight claims on behalf of Evans' customers. This role will manage the full lifecycle of a freight claim, including information collection, documentation validation, carrier filing, follow-up, negotiation, and payment resolution. The Claims Specialist plays a critical role in protecting customer interests, ensuring timely resolution, maximizing claim recoveries, and delivering a positive customer experience through detailed execution, persistence, and proactive communication. This role works closely with internal teams, carriers, and customers to ensure claims are handled accurately, efficiently, and in accordance with contractual and regulatory requirements. ESSENTIAL FUNCTIONS Collects and organizes all required documentation to initiate freight claims, including but not limited to bills of lading, delivery receipts, invoices, photos, inspection reports, and customer statements. Reviews and validates claim documentation for accuracy, completeness, and compliance prior to carrier submission. Files freight claims with carriers in accordance with carrier contracts, tariffs, and applicable regulations. Manages ongoing communication with carriers to track claim status, request updates, and resolve outstanding issues. Negotiates claim settlements with carriers to maximize recovery while maintaining professional carrier relationships. Ensures timely collection of approved claim payments and coordinates payment processing to customers. Maintains accurate and up-to-date claim records within internal systems and reporting tools. Provides proactive updates to internal stakeholders and customers regarding claim status, timelines, and outcomes. Identifies trends or recurring claim issues (damage, shortages, service failures, packaging concerns, etc.) and escalates insights to the Claims Manager. Partners with internal teams (Client Success, Operations, Finance, Sales) to support claim resolution and improve overall claims outcomes. Adheres to company policies, procedures, and best practices related to claims handling and customer communication. Supports continuous improvement initiatives related to claims processes, documentation standards, and carrier performance. Adheres to Evans' Five Guiding Principles and all departmental and company procedures, policies, and handbooks. All other duties as assigned. Requirements: QUALIFICATIONS AND REQUIREMENTS Associate's or Bachelor's Degree preferred. 1-3 years of experience in transportation, logistics, freight claims, customer service, or a related operational role. Prior experience handling freight claims or working with carriers is preferred but not required. Strong attention to detail and ability to manage multiple claims simultaneously. Excellent written and verbal communication skills, with the ability to professionally interact with customers and carriers. Strong critical thinking, problem-solving, and negotiation skills. Working knowledge of truckload and less-than-truckload transportation is preferred. Proficiency in Microsoft Office Suite (Excel, Outlook, Word); experience with Transportation Management Systems is a plus. High level of organizational skills with the ability to meet deadlines in a fast-paced environment. Ability to read, write, type, and speak English fluently is a requirement of this position. PHYSICAL DEMANDS / WORK ENVIRONMENT While performing the duties of this job, the employee must be able to use a keyboard, calculator, and telephone. Frequent sitting, talking, hearing, and close-vision work are required, with occasional standing and lifting (up to 10 lbs.). Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
    $72k-102k yearly est. 15d ago
  • Claims Representative - Workers Compensation

    West Bend Mutual Insurance 4.8company rating

    Claim specialist job in Madison, WI

    Recognized as a Milwaukee Journal Sentinel Top Workplace for 14 consecutive years, including three years of being honored as number one! Join us at West Bend, where we believe that our associates are our greatest asset. We hire talented individuals who are conscientious, dedicated, customer focused, and able to build lasting relationships. We create and maintain an environment where you feel a sense of belonging and appreciation. Your diversity of thought, experience, and knowledge are valued. We're committed to fostering a welcoming culture, offering you opportunities for meaningful work and professional growth. More than a workplace, we celebrate our successes and take pride in serving our communities. Job Summary When employees are injured on the job, they need someone who can guide them through the process with care and expertise. As a Workers' Compensation Claims Representative at West Bend, you'll guide injured employees through the recovery process, ensure fair and timely claim resolution, and help businesses stay compliant. If you thrive on problem-solving, negotiation, and making a real impact, this is your opportunity to lead with confidence. Work Location This position offers a hybrid schedule with three in-office collaboration days for team meetings and other events. In certain cases, highly qualified candidates with strong jurisdictional experience may be considered for a remote arrangement. The internal deadline to apply is 2/3/2026. External applications will be accepted on a rolling basis while the position remains open. Responsibilities & Qualifications As a Claims Representative, you will manage claims of varying complexity using current claim technology and best practices. You will conduct thorough investigations to determine coverage, evaluate damages/benefits, and assess liability/compensability. You will negotiate settlements with insureds, claimants, and attorneys while maintaining proactive file management, accurate reserving, and adherence to audit and regulatory standards. This role collaborates closely with internal partners and external stakeholders, with the scope of responsibility (including field work and regional liaison duties) increasing with experience level. Key Responsibilities * Investigate and resolve claims within assigned authority * Determine coverage, damages, and liability * Negotiate settlements with insureds, claimants, and attorneys * Maintain accurate documentation and reserving * Communicate promptly and professionally with all stakeholders * Collaborate with internal teams and external partners * Adhere to audit and compliance standards * Participate in training and team initiatives Preferred Experience and Skills * Prior experience managing claims at the appropriate level of complexity (from low/moderate to high-exposure/complex) * Proficiency with computers and current claim technology * Interpersonal, oral, and written communication skills with customer-focused professionalism * Negotiation, problem-solving, and conflict resolution skills * Time management and organizational discipline with proactive file handling * Independent decision-making ability (higher levels) and results orientation * Technical expertise in coverage analysis, compensability, and damages evaluation (higher levels) * Prior experience managing claims across multiple jurisdictions (higher levels) with preferred jurisdictions of Minnesota and Iowa Preferred Education and Training * Bachelor's degree in Business, Insurance or related field * Associate in General Insurance (AINS) designation * Associate in Claims (AIC) designation * CPCU coursework or other continuing education * Licensure in jurisdictions where required Salary Statement The salary range for this position is $67,000 - $100,000. The actual base pay offered to the successful candidate will be based on multiple factors, including but not limited to job-related knowledge/skills, experience, business needs, geographical location, and internal equity. Compensation decisions are made by West Bend and are dependent upon the facts and circumstances of each position and candidate. Benefits West Bend offers a comprehensive benefit plan including but not limited to: * Medical & Prescription Insurance * Health Savings Account * Dental Insurance * Vision Insurance * Short and Long Term Disability * Flexible Spending Accounts * Life and Accidental Death & Disability * Accident and Critical Illness Insurance * Employee Assistance Program * 401(k) Plan with Company Match * Pet Insurance * Paid Time Off. Standard first year PTO is 17 days, pro-rated based on month of hire. Enhanced PTO may be available for experienced candidates * Bonus eligible based on performance * West Bend will comply with any applicable state and local laws regarding employee leave benefits, including, but not limited to providing time off pursuant to the Colorado Healthy Families and Workplaces Act for Colorado employees, in accordance with its plans and policies. #LI-LW1 EEO West Bend provides equal employment opportunities to all associates and applicants for employment and prohibits discrimination and harassment of any type without regard to race, color, religion, age, sex, national origin, disability status, genetics, protected veteran status, sexual orientation, gender identity or expression, or any other characteristic protected by federal, state or local laws. This policy applies to all terms and conditions of employment, including recruiting, hiring, placement, and promotion.
    $32k-40k yearly est. Auto-Apply 5d ago
  • Drop/Add Deadline Adjustment

    Maranatha Baptist University 3.3company rating

    Claim specialist job in Watertown, WI

    Registrar's Office hours for this Friday are 10:30 AM-3:30 PM. Because of the cold weather and limited hours, please try to plan ahead and turn in your Drop/Add forms and application paperwork by tomorrow, January 22, for processing, so you can stay inside and warm on Friday! If needed, please email any outstanding paperwork on Friday to *****************. Submitted by: Emily Barclay
    $36k-42k yearly est. Easy Apply 11d ago

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  9. Group Health Cooperative Of Eau Claire

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