Sr. Workers Compensation Claims Representative

About Sentry Sentry Insurance is one of the country's largest and strongest mutual insurance companies. Sentry was founded in 1904 by members of the Wisconsin Retail Hardware Association. Today, Sentry has more than $8.5 billion in assets, a policyholder surplus of $2.3 billion and annual premiums in excess of $1.8 billion.

Sentry Insurance is headquartered in Stevens Point, Wisconsin, with claims and service offices located throughout the United States.

Sentry offers a full line of property, casualty and life insurance products to protect businesses, cars, homes, lives and retirement incomes.Job Description
About Sentry

Sentry Insurance is one of the country's largest and strongest mutual insurance companies. Sentry was founded in 1904 by members of the Wisconsin Retail Hardware Association. Today, Sentry has more than $8.5 billion in assets, a policyholder surplus of $2.3 billion and annual premiums in excess of $1.8 billion.

Sentry Insurance is headquartered in Stevens Point, Wisconsin, with claims and service offices located throughout the United States.

Sentry offers a full line of property, casualty and life insurance products to protect businesses, cars, homes, lives and retirement incomes.

Responsiblities
The Claim Service Center (CSC) is responsible for the administration of claims, with claim units handling specific insurance lines i.e., workers' compensation, liability, material damage, property, subrogation, medical/dental, disability/life, etc. The claim units investigate, evaluate and settle claims in an equitable manner, serving the interests of the Company, policyholder and claimant while providing superior customer service.

Receives claim assignments from manager and directly from the claim system. Verifies coverages and investigates losses by gathering pertinent information.

Takes recorded statements, obtains pertinent information i.e., police and medical reports, appraisals, estimates, photographs, degree of disability, rehabilitation potential, etc., and evaluates damages/eligibility for benefits, determines liability and sets reserves.

Evaluates claims and charges submitted by insureds and medical providers to determine eligibility for benefits, checking for misrepresentation, preexisting conditions and mandated state benefits if applicable.

Documents all decisions, correspondence, reports and discussions that occur during the investigation. Confers with higher level technical claim personnel for guidance and direction to ensure the file is handled properly.

Completes claim by evaluating the loss and settling the claim. Denies coverage where coverage does not exist. Determines if subrogation exists and takes steps necessary for recovery. Within assigned authority limits, settles and pays claim. Coordinates the payment of benefits with other insurance carriers if applicable. Monitors claim files during initial and residual periods to ensure file currency.

Refers the payment or denial of claims that exceed assigned authorization limits to Senior Claim Representative or Claim Manager with settlement recommendation. Detects potential problems or trends that require additional review, investigation or research and refers to Senior Claim Representative or Claim Manager for resolution.

Works closely with health facility, repair facility and/or contractors to facilitate necessary services or repair work. Advises the Claim Department of any special problems i.e., questionable repair shops. Notifies Underwriting of any adverse findings on a particular risk. Accurately codes data submitted to outside agencies or other Sentry functions.

In litigation situations, provides pertinent background information to legal counsel and assists as possible in reaching an in-court or out-of-court settlement.

Participates in administering fraud control procedures, evaluating and preparing reports, and drafting responses to formal complaints.

Performs other job-related duties i.e., receiving telephone claim reports, resolving complaints, completing assigned projects, requiring the same general knowledge, skill and degree of responsibility commensurate with the assigned level.Job Requirements
Qualifications

Knowledge of insurance policies and coverages, claim payment procedures, and familiarity with medical terminology is highly desirable. Previous insurance experience and/or coursework is beneficial. Must possess analytical abilities to review, exercise judgement, and evaluate claims to make sound decisions. Must have self-initiative. Must be able to review and interpret complex and detailed documents such as contracts, medical reports and insurance regulations. Effective oral and written communication skills and human relations skills are critical. Ability to maintain confidentiality is critical. Personal computer and math skills are helpful.

Compensation and Benefits

The starting salary can be up to $64,000 annually depending on experience and qualifications.

Sentry's excellent benefits package is designed to meet today's most important needs. Benefits for full-time Sentry Insurance employees include:


Group Health And Dental Insurance

Prescription Eyewear Plan

Group Life Insurance

401(K) Plan With Matching Funds

Retirement Plan

Paid-Time Off Or Time Away From Territory Plan

Pretax Dependent Care And Health Expense Reimbursement Accounts

Student Loan Program

Credit Union

Career Education

Careerbuilder related terms: Agency Sales, Property and Casualty, American Family, State Farm, Progressive, Geico, Account Representative, AIG, Allstate, Federated, Universal Underwriters, Farm Bureau, Farmers, Nationwide, Liberty Mutual, St. Paul Travelers, workers compensation, claim representative, claims