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Direct Claims Jobs in Wisconsin (NOW HIRING)

Trane Technologies plc

Claims Specialist

La Crosse, WI · On-site

Review, analyze and process claims per policies and procedures. * Assist offices, plants, and ... Work on process improvement projects, as directed. * Aid in claim help requests via Phone, Email ...

Trane Technologies plc

Claims Specialist

La Crosse, WI · On-site

Review, analyze and process claims per policies and procedures. * Assist offices, plants, and ... Work on process improvement projects, as directed. * Aid in claim help requests via Phone, Email ...

trane technologies

Claims Specialist

La Crosse, WI · On-site

Review, analyze and process claims per policies and procedures. * Assist offices, plants, and ... Work on process improvement projects, as directed. * Aid in claim help requests via Phone, Email ...

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All JobsDirect Claims JobsDirect Claims Jobs in Wisconsin

Direct Claims information

What is a direct claim?

Direct claims refer to insurance claims that are filed directly by the policyholder with their own insurance company, rather than going through a third party or the at-fault party's insurer. This process is common in situations like auto accidents, where the policyholder seeks compensation for damages or losses under their own policy. Direct claims help streamline the process, reduce delays, and ensure the policyholder receives prompt assistance and settlements. They are often associated with 'first-party' insurance coverage, such as collision, comprehensive, or health insurance claims.

What are the key skills and qualifications needed to thrive as a direct claims specialist?

To thrive as a Direct Claims Specialist, you need a solid understanding of insurance policies, claims processes, and relevant legal regulations, often supported by a degree in business, finance, or a related field. Familiarity with claims management software, customer relationship management (CRM) systems, and sometimes industry certifications like AIC or CPCU is typical. Exceptional attention to detail, problem-solving abilities, and strong communication skills set top performers apart in this role. These skills and qualifications ensure claims are processed accurately and efficiently, leading to customer satisfaction and minimized risk for the insurer.

What are some common challenges faced by professionals in direct claims roles, and how can they effectively manage these challenges?

Professionals in Direct Claims often face the challenge of balancing a high volume of claims with the need for thorough investigation and timely resolution. Managing customer expectations and handling sensitive situations, such as denied claims or complex cases, can also be demanding. Effective communication, strong organizational skills, and staying updated on policy guidelines are crucial for success. Building collaborative relationships with adjusters, underwriters, and other departments helps ensure accurate and efficient claims processing.

What is the difference between Direct Claims vs Claims Adjuster?

AspectDirect ClaimsClaims Adjuster
CredentialsInsurance license, knowledge of policiesInsurance license, sometimes certifications like AIC or CPCU
Work EnvironmentCustomer service, office or remoteFieldwork, office, or remote
Employer & IndustryInsurance companies, agenciesInsurance companies, third-party administrators
Search & Comparison IntentUnderstanding direct claims handlingEvaluating claims adjustment roles

Direct Claims professionals primarily handle claims directly from policyholders, focusing on processing and resolving claims within the insurance company. Claims Adjusters evaluate, investigate, and settle claims, often working in the field or remotely. Both roles require insurance licensing, but Claims Adjusters may have additional certifications. While their work overlaps in claims processing, Direct Claims roles are more customer-facing, whereas Claims Adjusters focus on assessment and negotiation.

What are popular job titles related to Direct Claims jobs in Wisconsin?

For Direct Claims jobs in Wisconsin, the most frequently searched job titles are:

What job categories do people searching Direct Claims jobs in Wisconsin look for?

The top searched job categories for Direct Claims jobs in Wisconsin are:

What cities in Wisconsin are hiring for Direct Claims jobs?

Cities in Wisconsin with the most Direct Claims job openings:

Direct Claims jobs near you
Infographic showing various Direct Claims job openings in Wisconsin as of August 2026, with employment types broken down into 1% As Needed, 78% Full Time, 15% Part Time, and 6% Contract. Highlights an 94% Physical, 1% Hybrid, and 5% Remote job distribution.

Claims Representative I (Workers' Compensation)

Society Insurance

Fond Du Lac, WI • On-site

Other

Medical, Dental, Vision, Life, Retirement, PTO

Re-posted yesterday

Job description

Claims Representative I (Workers' Compensation)

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 I (Workers' Compensation) to join our team. This role will investigate, evaluate, and resolve mildly complex Workers' Compensation claims by determining coverage and liability, coordinating with injured workers, employers, and medical providers, and negotiating appropriate claim resolutions in accordance with company guidelines, policy provisions, and state regulations.

About the Role
  • Handles and settles mildly complex claims by determining insurance carrier's liability; reaching agreement with claimants/injured workers according to policy provisions and authority level; and handling subrogation.
  • Determines insurance coverage by examining claim forms, policies, and other records; interviewing claimants/injured workers, insureds, and witnesses; reviewing police and hospital records; and consulting with experts when appropriate.
  • Resolves questionable claims by investigating and comparing claims information with evidence.
  • Ensures company guidelines and procedures are followed during investigations and in the handling of discovery and settlement.
  • Ensures proper file documentation by complying with claims handling guidelines and state requirements.
  • Prepares reports by collecting, analyzing, and summarizing claim information.
  • Develops and maintains professional, technical knowledge and expertise in a specified line(s) of business through training courses and participating in continuing education coursework/classes.
  • Contributes to team effort by participating in determining department investigation guidelines; and providing feedback to underwriting as needed.
About You
  • 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.
  • You apply an investigative approach to identifying facts and evaluating evidence.
What It Will Take
  • Bachelor's Degree in business or related field OR 3+ years of claims handling experience involving the exercise of discretionary decision-making as determined by Society Insurance OR 5+ years of knowledge in the property & casualty insurance industry
  • Familiarity with PC applications including word processing, Internet, spreadsheets, and e-mail software.
  • Ability to obtain and maintain proper licensing prior to handling a state that requires it.
  • Valid driver's license and a satisfactory driving record as determined by Society Insurance.
  • Prior workers' compensation indemnity experience highly desirable.
  • Professional insurance designations highly desirable.
What Society Can Offer
  • Comprehensive Benefits Package: Salary with bonus plan; health, dental, life, and vision insurance
  • Retirement: Traditional or Roth 401(k) Defined Contribution Plan PLUS Profit-Sharing Plan
  • Work-Life Balance: Company-paid holidays; flexible scheduling; PTO; telecommuting options
  • Education: Career Coaching; company-paid courses; student loan and tuition reimbursement
  • Community: Charitable Match; paid volunteer time; team sponsorships
  • Wellness: 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.

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