Auto First Party Medical Claim Representative - Albany, NY
About The Position
The Auto First Party Medical Claim Representative handles first-party medical claims from initial notice of loss through resolution, settlement, and payment. The role works with eligible parties, medical providers, attorneys, and internal stakeholders to resolve claims efficiently and professionally, providing empathetic service throughout the process. The representative generally handles personal insurance claims with limited supervision and higher authority, and begins handling business insurance claims with direct supervision. Relevant insurance license(s) must be acquired and maintained within three months of starting.
Requirements
- High school diploma or GED.
- One year of auto claim handling experience, comparable claim experience, or successful completion of the required Travelers Claim Representative training program.
- Acquire and maintain relevant insurance license(s) within three months of starting.
Nice To Haves
- Bachelor’s degree.
- Two years of auto claim handling experience.
- Active adjuster license, where applicable.
- Proficiency in claims management software, with advanced skills in Microsoft Office and enterprise technology systems and platforms.
- Strong verbal and written communication skills.
- Sound judgment and effective decision-making ability.
- Exceptional customer service skills and commitment to a positive customer experience.
- Strong attention to detail and organizational skills, including managing multiple tasks and prioritizing in a fast-paced environment.
- Conflict resolution skills and the ability to facilitate productive discussions and reach equitable outcomes.
- Ability to manage stress, navigate difficult situations, maintain composure and professionalism under pressure, and take accountability for decisions.
- Basic understanding of insurance principles and terminology, state insurance regulations, and claim handling requirements.
- Ability to learn quickly from experience and apply it to new situations with speed and flexibility.
Responsibilities
- Review, investigate, and document Auto First Party Medical claims under limited supervision.
- Gather information from eligible parties, medical providers, and attorneys.
- Investigate and evaluate relevant facts to determine coverage, causation and damages, medical necessity, treatment plans, and exposures.
- Manage medical treatment based on injury details, treatment received or anticipated, and wage loss, using case management and medical resources as needed; ensure proper payment.
- Communicate promptly and professionally with eligible parties, medical providers, attorneys, and internal stakeholders.
- Determine settlement amounts, negotiate, and convey claim settlements to eligible parties as appropriate.
- Maintain accurate records of claim activity in claim management systems.
- Continue learning and adopt emerging technologies, including AI and digital transformation tools.
- Adapt to technology implementations, system upgrades, and digital tool rollouts while maintaining productivity and service quality.
- Acquire and maintain relevant insurance licenses to comply with state and Travelers’ requirements within three months of starting.
- Perform other duties as assigned.
Benefits
- Employees are eligible for performance-based cash incentive awards as part of the compensation and benefits program.
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What This Job Offers
Job Type
Full-time
Career Level
Mid Level
Education Level
High school or GED
