Society Insurance Company
Fond Du Lac, Wisconsin
Job Information Job Title Claims Representative II-General Liability (Bodily Injury focused) Home Department: Claims Employment Status: Exempt; Full-time Schedule: 40 hours/week with Flexible Scheduling Opportunities Position Location: Home Office, Telecommuting, and Remote Opportunities in: CO, GA, IL, IN, IA, MN, TN, TX, & WI Overview Protecting our policyholders' dreams, passions, and livelihoods has a direct impact on the communities we serve. We work towards excellence, conduct ourselves with high integrity, and take our work seriously, but not ourselves. Small Details. Big Difference. Find out how you can make a difference with a career at Society. Society Insurance is seeking a Claims Representative who excels at managing moderate to complex bodily injury and general liability claims. This role focuses on investigating losses, determining liability, and negotiating out of court settlements for mildly complex general liability claims. Successful candidates will have experience handling represented bodily injury claims, with a strong emphasis on Commercial General Liability (CGL) and premises liability exposures, along with the judgment and negotiation skills needed to navigate matters that advance into litigation. About the Role Settles mildly complex claims by determining insurance carrier's liability and reaches agreement with claimant according to policy provisions and authority level.May be involved with litigation by analyzing negotiated settlement options; evaluating evidence, and overseeing attorney in the handling of discovery and settlement.Handles mediations, arbitrations, subrogation, and recorded settlement agreements.Determines coverage through investigations by examining claim forms, policies, and other records; interviewing claimants, insureds, and witnesses; consulting police and hospital records; inspecting damages; and consulting with experts when appropriate.Mentors and trains claims representatives in claims expertise by assisting in identifying training needs and opportunities.Resolves questionable claims by investigating the claim and comparing claims information with evidence.Ensures proper file documentation of assigned files by complying with company and state requirements.Prepares reports by collecting, analyzing, and summarizing claim information.Contributes to team effort (as needed) by participating on catastrophe teams; participating in determining department investigation guidelines; providing feedback to underwriting as needed. About Yo u You enjoy communicating and building relationships with others.You are composed, cool under pressure, and can negotiate without damaging relationships. You hold yourself accountable and act in accordance with rules and regulations. You enjoy analyzing, investigating, and using the facts to make decisions. You are naturally curious and have a desire to know more. What it Will Take Bachelor's Degree and 3+ years of claims handling experience OR 5+ years of claims handling experience.Proficiency in general liability claims demonstrated through knowledge and experience in insurance policies and coverage, claim payment procedures, insurance regulations, and legal terminology. Ability to obtain and maintain proper licensing prior to handling a state that requires it. Professional insurance designations highly desirable.Litigation Experience highly desirable.Experience using Guidewire Claims System highly desirable. What Society Can Offer Comprehensive Benefits Package: Salary with bonus plan; health, dental, life, and vision insuranceRetirement: Traditional or Roth 401(k) Defined Contribution Plan PLUS Profit-Sharing PlanWork-Life Balance: Company-paid holidays; flexible scheduling; PTO; telecommuting optionsEducation: Career Coaching; company-paid courses; student loan and tuition reimbursementCommunity: Charitable Match; paid volunteer time; team sponsorshipsWellness: Employee Assistance Program; wellness initiatives/rewards; health coaching; and more Society Insurance prohibits discrimination and harassment of any type against applicants and employees on the basis of race, color, religion, sex, national origin, age, handicap, disability, genetics, veteran status or military service, marital status or sexual orientation, gender identity or expression, or any other characteristic or status protected by federal, state or local laws. Society Insurance also provides reasonable accommodations to qualified individuals with disabilities in accordance with the requirements of the Americans with Disabilities Act and applicable state and local laws. Society Insurance is a drug-free workplace. PI99fa4b4052a7-7021
Job Information Job Title Claims Representative II-General Liability (Bodily Injury focused) Home Department: Claims Employment Status: Exempt; Full-time Schedule: 40 hours/week with Flexible Scheduling Opportunities Position Location: Home Office, Telecommuting, and Remote Opportunities in: CO, GA, IL, IN, IA, MN, TN, TX, & WI Overview Protecting our policyholders' dreams, passions, and livelihoods has a direct impact on the communities we serve. We work towards excellence, conduct ourselves with high integrity, and take our work seriously, but not ourselves. Small Details. Big Difference. Find out how you can make a difference with a career at Society. Society Insurance is seeking a Claims Representative who excels at managing moderate to complex bodily injury and general liability claims. This role focuses on investigating losses, determining liability, and negotiating out of court settlements for mildly complex general liability claims. Successful candidates will have experience handling represented bodily injury claims, with a strong emphasis on Commercial General Liability (CGL) and premises liability exposures, along with the judgment and negotiation skills needed to navigate matters that advance into litigation. About the Role Settles mildly complex claims by determining insurance carrier's liability and reaches agreement with claimant according to policy provisions and authority level.May be involved with litigation by analyzing negotiated settlement options; evaluating evidence, and overseeing attorney in the handling of discovery and settlement.Handles mediations, arbitrations, subrogation, and recorded settlement agreements.Determines coverage through investigations by examining claim forms, policies, and other records; interviewing claimants, insureds, and witnesses; consulting police and hospital records; inspecting damages; and consulting with experts when appropriate.Mentors and trains claims representatives in claims expertise by assisting in identifying training needs and opportunities.Resolves questionable claims by investigating the claim and comparing claims information with evidence.Ensures proper file documentation of assigned files by complying with company and state requirements.Prepares reports by collecting, analyzing, and summarizing claim information.Contributes to team effort (as needed) by participating on catastrophe teams; participating in determining department investigation guidelines; providing feedback to underwriting as needed. About Yo u You enjoy communicating and building relationships with others.You are composed, cool under pressure, and can negotiate without damaging relationships. You hold yourself accountable and act in accordance with rules and regulations. You enjoy analyzing, investigating, and using the facts to make decisions. You are naturally curious and have a desire to know more. What it Will Take Bachelor's Degree and 3+ years of claims handling experience OR 5+ years of claims handling experience.Proficiency in general liability claims demonstrated through knowledge and experience in insurance policies and coverage, claim payment procedures, insurance regulations, and legal terminology. Ability to obtain and maintain proper licensing prior to handling a state that requires it. Professional insurance designations highly desirable.Litigation Experience highly desirable.Experience using Guidewire Claims System highly desirable. What Society Can Offer Comprehensive Benefits Package: Salary with bonus plan; health, dental, life, and vision insuranceRetirement: Traditional or Roth 401(k) Defined Contribution Plan PLUS Profit-Sharing PlanWork-Life Balance: Company-paid holidays; flexible scheduling; PTO; telecommuting optionsEducation: Career Coaching; company-paid courses; student loan and tuition reimbursementCommunity: Charitable Match; paid volunteer time; team sponsorshipsWellness: Employee Assistance Program; wellness initiatives/rewards; health coaching; and more Society Insurance prohibits discrimination and harassment of any type against applicants and employees on the basis of race, color, religion, sex, national origin, age, handicap, disability, genetics, veteran status or military service, marital status or sexual orientation, gender identity or expression, or any other characteristic or status protected by federal, state or local laws. Society Insurance also provides reasonable accommodations to qualified individuals with disabilities in accordance with the requirements of the Americans with Disabilities Act and applicable state and local laws. Society Insurance is a drug-free workplace. PI99fa4b4052a7-7021
OptumCare
San Antonio, Texas
Do you have compassion and a passion to help others? Transforming healthcare and millions of lives as a result starts with the values you embrace and the passion you bring to achieve your lifes best work.(sm) The Cardiology RN is responsible for carrying out day-to-day support duties and facilitating teaching related to the Chronic Care, Heart Failure, and Ischemic Heart Disease. The Cardiology RN works in conjunction with the Cardiology team, providers, clinic staff and primary care physicians. This position assists in providing patient empowerment through the use of motivational interviewing skills, problem solving and self-management goal setting. Primary Responsibilities: Works with the providers and clinic staff to identify patients with Heart failure, IHD and ensures clinical guidelines are being followed Triage patients, administer IV therapy under the direction of the providers, and relay test results after provider interpretation Conducts Chronic Care Model visits and reviews the patients informal and formal support systems, focusing on what patients want to improve and educating them about their chronic disease Utilizes appropriate motivational interviewing techniques necessary for coaching and assisting the patient to complete self-management goal / action plans Enters timely and accurate data into the EMR system and other applications necessary to communicate patient needs and to ensure complete documentation of patient visits and phone calls Responsible for remote monitoring of patients, setting parameters with provider direction, identify changes in patient vitals, conduct on - going discussions in regards to disease management with the providers Maintains current knowledge regarding HF, IHD as well as treatments and medications related to each Establishes a trusting relationship with identified patients, caregivers, clinic staff members and physicians Conducts clinic one-on-one visits with patients, triaging, educated on disease, diet, assess patient needs. Communicates these needs to the appropriate person (i.e. Social Worker, clinic staff, etc.) or addresses them per process Solves problems by gathering and / or reviewing facts and selecting the best solution from identified alternatives. Decision making is usually based on prior practice or policy, with some interpretation. Applies individual reasoning to the solution of a problem devising or modifying processes and writing procedures Serves as a resource or consultant for LVN / MA team members Attends educational offerings to keep abreast of change and complies with licensing requirements, ensures all patient educational materials are up-to-date, and maintains knowledge of specialty and ancillary provider contract contents, to include exclusions and contract terms Collaborates with the cardiology team to recommend policies, procedures and standards which affect the care of the patient with high-risk chronic disease diagnoses such as HF, IHD, and all Cardiology related diseases Exhibits professionalism and is courteous with all patients, physicians and co-workers Performs all other related duties as assigned This position is located at WellMed, Specialist for Health Crockett Park / Downtown San Antonio, minutes for Metropolitan Methodist . This position may require assisting other locations as needed - Mileage reimbursement available Youll be rewarded and recognized for your performance in an environment that will challenge you and give you clear direction on what it takes to succeed in your role as well as provide development for other roles you may be interested in.
Do you have compassion and a passion to help others? Transforming healthcare and millions of lives as a result starts with the values you embrace and the passion you bring to achieve your lifes best work.(sm) The Cardiology RN is responsible for carrying out day-to-day support duties and facilitating teaching related to the Chronic Care, Heart Failure, and Ischemic Heart Disease. The Cardiology RN works in conjunction with the Cardiology team, providers, clinic staff and primary care physicians. This position assists in providing patient empowerment through the use of motivational interviewing skills, problem solving and self-management goal setting. Primary Responsibilities: Works with the providers and clinic staff to identify patients with Heart failure, IHD and ensures clinical guidelines are being followed Triage patients, administer IV therapy under the direction of the providers, and relay test results after provider interpretation Conducts Chronic Care Model visits and reviews the patients informal and formal support systems, focusing on what patients want to improve and educating them about their chronic disease Utilizes appropriate motivational interviewing techniques necessary for coaching and assisting the patient to complete self-management goal / action plans Enters timely and accurate data into the EMR system and other applications necessary to communicate patient needs and to ensure complete documentation of patient visits and phone calls Responsible for remote monitoring of patients, setting parameters with provider direction, identify changes in patient vitals, conduct on - going discussions in regards to disease management with the providers Maintains current knowledge regarding HF, IHD as well as treatments and medications related to each Establishes a trusting relationship with identified patients, caregivers, clinic staff members and physicians Conducts clinic one-on-one visits with patients, triaging, educated on disease, diet, assess patient needs. Communicates these needs to the appropriate person (i.e. Social Worker, clinic staff, etc.) or addresses them per process Solves problems by gathering and / or reviewing facts and selecting the best solution from identified alternatives. Decision making is usually based on prior practice or policy, with some interpretation. Applies individual reasoning to the solution of a problem devising or modifying processes and writing procedures Serves as a resource or consultant for LVN / MA team members Attends educational offerings to keep abreast of change and complies with licensing requirements, ensures all patient educational materials are up-to-date, and maintains knowledge of specialty and ancillary provider contract contents, to include exclusions and contract terms Collaborates with the cardiology team to recommend policies, procedures and standards which affect the care of the patient with high-risk chronic disease diagnoses such as HF, IHD, and all Cardiology related diseases Exhibits professionalism and is courteous with all patients, physicians and co-workers Performs all other related duties as assigned This position is located at WellMed, Specialist for Health Crockett Park / Downtown San Antonio, minutes for Metropolitan Methodist . This position may require assisting other locations as needed - Mileage reimbursement available Youll be rewarded and recognized for your performance in an environment that will challenge you and give you clear direction on what it takes to succeed in your role as well as provide development for other roles you may be interested in.