Senior Workers Compensation Claim Representative

Travelers • Buffalo, NY

1d

About The Position

Under general supervision, manages Workers’ Compensation claims involving lost time through conclusion and negotiates settlements when appropriate. The role coordinates the medical and indemnity strategy with a Medical Case Manager and independently manages claims ranging from low to moderate complexity through most complex matters. Claim scenarios may include ongoing medical treatment, modified or permanent work restrictions, litigation, vocational rehabilitation, permanent partial disability, reopened claims, complex offsets, multiple surgeries, knee replacements, fatalities, and potential settlements.

The position requires investigation and evaluation of claims, establishment and adjustment of reserves, coordination with medical and legal specialists, and proactive management toward appropriate resolution and file closure. The representative may provide technical expertise and mentoring to other Claim Professionals and may manage specialized or sensitive accounts. Insurance license acquisition and maintenance may be required under state and Travelers requirements, generally within three months of starting, with continuing education as required.

Requirements

• High school diploma or equivalent.
• At least 2 years of Workers’ Compensation claim handling experience.
• Advanced evaluation, negotiation, and case resolution skills.
• Ability to analyze information, identify problems and opportunities, understand cause-and-effect relationships, and consider alternative solutions.
• Clear and concise oral and written communication skills, including the ability to present claim resolutions to stakeholders.
• Knowledge of insurance policies and contracts and the ability to apply policy terms to loss facts.
• Intermediate investigative skills, including the ability to take statements and follow a logical inquiry process.
• Advanced ability to determine liability, value damages, and establish and adjust reserves.
• Advanced knowledge of settlement techniques and preparation of settlement offers.
• Thorough knowledge and application of applicable state, federal, and regulatory laws, statutes, rules of evidence, trial preparation, discovery, and court proceedings.
• Intermediate knowledge of injuries, disability periods, and necessary treatment.
• Advanced Workers’ Compensation technical knowledge, including the ability to use available resources and technology and work within assigned jurisdictional parameters.
• Advanced customer service skills and ability to build productive relationships with insureds.
• Advanced teamwork skills in situations involving interdependent work and shared responsibility.
• Advanced planning and organizing skills to establish action plans and contingencies.

Responsibilities

• Investigate claims by assessing policy coverage and contacting insureds, injured workers, medical providers, and other parties in a timely manner to determine compensability.
• Establish and update claim and actuarial reserves, documenting the rationale and reflecting claim exposure.
• Determine the causal relationship of medical conditions and evaluate injuries, treatment, disability, and claim exposure.
• Manage files for quality through timely contact, proper documentation, and proactive resolution of outstanding issues.
• Develop and implement strategies for statutory benefit entitlement, medical diagnoses, Medicare Set Asides, and other issues to achieve appropriate claim outcomes.
• Coordinate medical services and claim strategy with internal nurse resources and Medical Case Managers.
• Collaborate with medical, legal, and other specialty resources to pursue resolution opportunities, including return to work, structured settlements, and discontinuation of benefits through litigation.
• Prepare required letters and state filings within statutory limits.
• Pursue offset opportunities, including apportionment, contribution, and subrogation, and evaluate claims for potential fraud.
• Proactively manage claim inventory with documented action plans to support timely and appropriate closure or reassignment.
• Manage moderate to complex litigation and work toward optimal claim outcomes, including resolution of benefits.
• Negotiate settlements within designated authority and use structured settlements or annuities when appropriate for the jurisdiction.
• Respond to verbal and written inquiries and keep injured workers apprised of claim status.
• Participate in telephonic and/or onsite file reviews and engage specialty resources as needed.
• Apply technical expertise to resolve complex claims, act as a technical resource, and mentor other Claim Professionals.
• May manage special account relationships or a specialized inventory of Workers’ Compensation claims.
• Obtain and maintain any required insurance licenses and complete continuing education as required.
• Perform other assigned duties.

Benefits

• Health insurance coverage for employees and eligible family members beginning on the first day of employment.
• Dollar-for-dollar 401(k) match on contributions up to the first 5% of eligible pay, subject to an annual maximum.
• Paying it Forward Savings Program, through which Travelers makes an annual 401(k) contribution when an employee makes a student loan payment.
• Pension Plan funded 100% by Travelers.
• At least 20 days of paid time off annually and nine paid company holidays.
• Wellness program with tools, discounts, and resources for wellness and caregiving needs.
• Mental health program offering access to free professional counseling, health coaching, and other resources.
• Matching Gift and Volunteer Rewards program.

What This Job Offers

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