Claim Representative, Auto FPM

The Travelers Companies•Melville, NY

34d

About The Position

This position is responsible for handling Personal and Business Insurance First Party Medical claims from the first notice of loss through resolution/settlement and payment process. This may include applying laws and statutes for multiple state jurisdictions. Provides quality claim handling throughout the claim life cycle (customer contacts, coverage, investigation, evaluation, reserving, negotiation and resolution) including maintaining full compliance with internal and external quality standards and state specific regulations.

Requirements

High School Degree or GED with a minimum of one year auto claim handling experience or successful completion of Travelers Claim Representative training program.

Nice To Haves

Associate's Degree or Bachelor's degree with 2 years auto claim handling experience.
Prior Auto First Party Medical experience.
Knowledge of medical terminology.
Demonstrated ownership attitude and customer centric response to all assigned tasks.
Attention to detail ensuring accuracy.
Ability to work in a high volume, fast paced environment managing multiple priorities.
Keyboard skills and Windows proficiency, including Excel and Word - Intermediate.
Verbal and written communication skills - Intermediate.
Analytical Thinking: Intermediate.
Judgment/Decision Making: Intermediate.
Negotiation: Intermediate.
Insurance Contract Knowledge: Intermediate.
Principles of Investigation: Intermediate.
Value Determination: Intermediate.
Settlement Techniques: Intermediate.
Legal Knowledge: Basic.
Medical Knowledge: Intermediate.

Responsibilities

Delivers consistent service quality throughout the claim life cycle, including but not limited to prompt contact, explaining the process, setting expectations, on-going communication, follow-through and meeting commitments to achieve optimal outcome on every file. Fulfills specific service commitments made to certain accounts, as outlined in Special Account Communication (SAC).
Reviews and analyzes coverage and applies policy conditions, provisions, exclusions and endorsements for assigned jurisdictions. Verifies the benefits available, the injured party's eligibility and the applicable limits. Addresses proper application of any deductibles, co-insurance, coverage limits, etc. Confirms priority of coverage (i.e. primary, secondary, concurrent) and takes into consideration other issues such as Social Security, Workers Compensation or others relevant to the jurisdiction.
Investigates each claim to obtain relevant facts necessary to determine coverage, causation/damages, medical necessity, treatment plan, damages, and exposure with respect to the various coverages provided through prompt contact with appropriate parties (e.g. policyholders, medical providers and technical experts). This may also include investigation of wage loss and essential services claims. Takes recorded statements as necessary.
Proactively manages medical treatment based on the nature and extent of injury, mechanism of injury, type of treatment received or anticipated, and wage loss through case management and use of medical resources as needed. Proactively manages the process to ensure proper payment, (i.e. review medical bills and medical records for appropriateness of billing/fees and the services rendered ensuring that all records have a determination of medical necessity and causal relationship to the loss).
Establishes timely and maintains appropriate claim and expense reserves to reflect the overall claim exposure. Manages file inventory and expense reserves by utilizing an effective diary system, documenting claim file activities to resolve claim in a timely manner.
Determines settlement amounts, negotiates and conveys claim settlements within authority limits to insureds and claimants. As appropriate, writes denial letters, Reservation of Rights and other necessary correspondence to insureds and claimants.
May handle litigated files on appropriately assigned cases. Develops resolution plan with staff or panel counsel, and track and control legal expenses; Reviews conciliations and prepares submissions for arbitration and/or mediation hearings. May also attend arbitrations as Company witness.
In order to perform the essential functions of this job, acquisition and maintenance of Insurance License(s) may be required to comply with state and Travelers requirements. Generally, license(s) must be obtained within three months of starting the job and obtain ongoing continuing education credits as mandated.
Perform other duties as assigned.

Benefits

Health Insurance: Employees and their eligible family members - including spouses, domestic partners, and children - are eligible for coverage from the first day of employment.
Retirement: Travelers matches your 401(k) contributions dollar-for-dollar up to your first 5% of eligible pay, subject to an annual maximum. If you have student loan debt, you can enroll in the Paying it Forward Savings Program. When you make a payment toward your student loan, Travelers will make an annual contribution into your 401(k) account. You are also eligible for a Pension Plan that is 100% funded by Travelers.
Paid Time Off: Start your career at Travelers with a minimum of 20 days Paid Time Off annually, plus nine paid company Holidays.
Wellness Program: The Travelers wellness program is comprised of tools, discounts and resources that empower you to achieve your wellness goals and caregiving needs. In addition, our mental health program provides access to free professional counseling services, health coaching and other resources to support your daily life needs.
Volunteer Encouragement: We have a deep commitment to the communities we serve and encourage our employees to get involved. Travelers has a Matching Gift and Volunteer Rewards program that enables you to give back to the charity of your choice.

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