FPM Arbitration Litigation Claim Representative

Travelers • Melville, NY

1d

About The Position

This position handles First Party Medical Litigation or Arbitration claims from the first notice of suit/arbitration to resolution/settlement and payment process. Provides quality claim handling throughout the litigation/arbitration life cycle (attorney/provider 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.
• One year prior First Party Medical or litigation claim handling experience.

Nice To Haves

• Associate's or Bachelor's degree or equivalent business experience.
• Prior First Party Medical and/or litigation claim handling experience.
• Strong keyboard skills and Windows proficiency, including Excel and Word.
• Demonstrated ownership attitude and customer centric response to all assigned tasks.
• Strong verbal and written communication skills.
• Attention to detail ensuring accuracy.
• Ability to work in a high volume, fast paced environment managing multiple priorities.
• Analytical Thinking - Intermediate.
• Judgment/Decision Making - Intermediate.
• Communication - Intermediate.
• Negotiation - Intermediate.
• Insurance Contract Knowledge - Intermediate.
• Principles of Investigation- Intermediate.
• Value Determination - Intermediate.
• Settlement Techniques - Intermediate.
• Legal Knowledge - Intermediate.
• Medical Knowledge - Intermediate.

Responsibilities

• Coverage Analysis: Review and analyze coverage and policy conditions, provisions, exclusions and endorsements, and how jurisdictional issues impact the claim. Confirm the benefits available, the injured party's eligibility and the applicable limits. Confirm proper application of any deductibles, coverage limits, etc. Confirm priority of coverage i.e.: primary, secondary, concurrent or not applicable, and take into consideration other issues such as Social Security, Workers Compensation or others relevant to the jurisdiction.
• Investigation/Evaluation: Evaluate each suit/arbitration to obtain relevant facts necessary to determine defensibility and potential exposure. Prompt review of claim file and handling procedures to determine validity of the action. Review of current legal/jurisdictional resources and applicable case law in conjunction with Claim counsel and First Party Medical claim professional, if necessary. Proactively manage ongoing litigation/arbitration through prompt, consistent follow up with Claim counsel and other applicable resources.
• Reserving: Establish timely and maintain appropriate claim and expense reserves to reflect the overall claim exposure. Manage file inventory and expense reserves by utilizing an effective diary system, documenting claim file activities to resolve claim in a timely manner.
• Negotiation/Resolution: Determine settlement amounts, negotiate and convey claim settlements within authority limits to attorneys, providers and claimants. As appropriate, write denial letters, Reservation of Rights and other necessary correspondence to attorneys, providers and claimants. Develop resolution plan with staff or panel counsel, and track and control legal expenses; Review conciliations and prepare submissions for arbitration and/or mediation hearings. May also attend arbitrations as Company witness. Attend depositions, mediations, arbitrations, pre-trials, trials and all other legal proceedings, as needed. Recognize and engage the appropriate resources (i.e. Nurse, SIU, claim counsel, property, etc.) to move the file towards appropriate resolution. Identify subrogation opportunities, determine appropriateness of the demand and negotiate adverse subrogation and arbitration. Recognize cases based on severity protocols to be referred timely to next level claim professional.
• 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.

What This Job Offers

• Job Type: Full-time
• Career Level: Entry Level
• Education Level: High school or GED