Claims Representative II - General Liability (Bodily Injury focused) Location: Fond du Lac, Wisconsin, US; Home Office, Telecommuting, and Remote Opportunities in: CO, GA, IL, IN, IA, MN, TN, TX, & WI Department: 0.25 Home Department: Claims Employment Status: Exempt; Full-time Schedule: 40 hours/week with Flexible Scheduling Opportunities Job Description: 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 II 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 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. 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 highlydesirable.Experience using Guidewire Claims System 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.

Role Description Seneca is looking for a senior claims specialist who enjoys being a key part of a dynamic team. As a Senior Claims Examiner, you will manage an assigned pending of claims arising from insurance policies, primarily Commercial General Liability with mid-to-high level of risk and complexity. You will also be expected to operate under appropriate levels of supervision and within established authority. The position will report to assigned Manager, AVP or Vice President, as determined by business needs. This position can be in one of our offices in New York, NY, Jersey City, NJ, Morristown, NJ, or Alpharetta, GA, with flexible work options available. Remote locations will also be considered for the right candidate. What you will do for C&F: - Receives claims assignments. Verifies and determines applicability of coverage. - Determines the method and extent of investigation for each claim as required by company Best Practices. - Reviews and manages outstanding files, as assigned, for adequacy and timeliness of investigation, evaluation and reserve and maintains a timely diary for each case. - Evaluates and adjusts claims within the adjuster’s authority level. - Reports directly on technical matters to supervisor or management. - Evaluates and manages litigated claims, determines future course of handling and proper method of disposition. Consults with the claim manager on those claims in which assistance and consultation is needed, as well as on those claims which exceed assigned authority. - Assesses recovery potential and is responsible for the development of information required to successfully pursue recovery. - Meets with current and prospective customers to discuss Seneca claims capabilities and address specific claim needs. - Accountable for the equitable and prompt adjustment and management of assigned claims to disposition in accordance with company Best Practices. - Responsible for providing superior customer service to all agents, insureds, and others encountered during the claims handling process. - Understanding/knowledge of contractual indemnity and additional insured risk transfer opportunities preferred. Qualifications - Bachelor’s degree or equivalent and 6+ years’ experience handling general liability claims, including New York Labor Law and catastrophic bodily injury claims, with some experience managing coverage-related matters filed by or against the insurer. - Designation and/or insurance related courses are a plus. - Obtain and maintain required state licenses. - Excellent verbal and written communication skills are essential and the ability to communicate with all levels within the organization. - Computer skills with a working knowledge of the Microsoft Office suite of programs a must. - Travel occasionally required. Benefits - Competitive compensation package - Generous 401K employer match - Employee Stock Purchase plan with employer matching - Generous Paid Time Off - Excellent benefits that go beyond health, dental & vision. Our programs are focused on your whole family’s wellness, including your physical, mental and financial wellbeing - A core C&F tenet is owning your career development, so we provide a wealth of ways for you to keep learning, including tuition reimbursement, industry-related certifications and professional training to keep you progressing on your chosen path - A dynamic, ambitious, fun and exciting work environment - We believe you do well by doing good and want to encourage a spirit of social and community responsibility, matching donation program, volunteer opportunities, and an employee-driven corporate giving program that lets you participate and support your community - At C&F you will BELONG

• Managing all aspects of litigated cases, including evaluation of the resolution process • Analyze auto claims to identify areas of dispute, investigating and gathering all necessary information and documentation, evaluating liability and damages and negotiating and resolving claims with opposing parties or their insurance providers • Manage litigation cases related to auto claims disputes, communicating regularly with clients, attorneys, vendors and other stakeholders • Review legal documents and ensuring compliance with initial suit-handling plan of action. • Analyze policy language and reaching appropriate coverage decisions. • Direct and control the activities and costs of outside vendors including defense counsel and coverage counsel, experts and independent adjusters • Maintain the appropriate adjuster licenses and continuing education requirements

Role Description The Claims Adjudicator II position will receive, examine, verify and input submitted claim data, determine eligibility status, and review and adjudicate claims within established timeframes. This position utilizes multiple systems in order to perform the day-to-day functions of processing medical, disability, vision and dental claims, as well as, provider and member driven inquiries. - Screens claims for completeness of necessary information - Verifies participant/dependent eligibility - Interprets the plan benefits from the Summary Plan Description (SPD)/Plan Documents - Codes basic information and selects codes to determine payment liability amount - Evaluates diagnoses, procedures, services, and other submitted data to determine the need for further investigation in relation to benefit requirements, accuracy of the claim filed, and the appropriateness or frequency of care rendered - Determines the need for additional information or documentation from participants, employers, providers and other insurance carriers - Handles the end to end process of Medicare Secondary Payer (MSP) files - Processes Personal Injury Protection (PIP) claims - Requests overpayment refunds, maintains corresponding files and performs follow-up actions - Handles verbal and written inquiries received from internal and external customers - Processes Short Term Disability claims - Adjudicates claims according to established productivity and quality goals - Achieve individual established goals in order to meet or exceed departmental metrics Qualifications - 3 ~ 5 years of direct experience minimum in a medical claim adjudication environment - Working knowledge and experience in interpretation of benefit plans, including an understanding of limitations, exclusions, and schedule of benefits - Experience with eligibility verification, medical coding, coordination of benefits, and subrogation and its related processes - Experience with medical terminology, ICD10 and Current Procedural Technology (CPT) codes - Fluency (speak and write) in Spanish, preferred Requirements - Salary range for this position: Hourly $20.36 - $24.97 - Actual base salary may vary based upon, but not limited to: relevant experience, qualifications, expertise, certifications, licenses, education or equivalent work experience, time in role, peer and market data, prior performance, business sector, and geographic location. - Work Schedule (may vary to meet business needs): Monday~Friday, 7.5 hours per day (37.5 hours per week) Fully Remote, after 1-week training onsite in Oak Brook, IL. (Travel and Lodging paid for by UHH) Benefits - Medical - Dental - Vision - Paid Time-Off (PTO) - Paid Holidays - 401(k) - Pension - Short- & Long-term Disability - Life - AD&D - Flexible Spending Accounts (healthcare & dependent care) - Commuter Transit - Tuition Assistance - Employee Assistance Program (EAP)