Senior Workers Compensation Claim Representative

Travelers • Albany, NY

2d • $72,200 - $119,000

About The Position

Under general supervision, manage Workers’ Compensation claims with lost time through conclusion and negotiate settlements where appropriate. Coordinate the medical and indemnity positions of claims with a Medical Case Manager. Independently handle claims ranging from low to moderate complexity to highly complex cases, including claims involving wage loss, modified or permanent work restrictions, ongoing treatment, permanent partial disability (PPD), litigation, vocational rehabilitation, reopened claims, multiple surgeries, complex offsets, fatalities, and settlement opportunities.

The role conducts claim investigations, establishes and updates reserves, develops claim strategies, coordinates medical services, manages litigation, pursues resolution and settlement options, and maintains timely and well-documented files. The representative may mentor other Claim Professionals and serve as a technical resource. Insurance licenses may be required; generally, applicable licenses must be obtained within three months of starting, with continuing education maintained as required.

Requirements

• High school diploma or equivalent.
• At least 2 years of Workers’ Compensation claim handling experience.
• Advanced analytical, communication, negotiation, value determination, and settlement skills.
• Knowledge of insurance contracts, investigative principles, and applicable state, federal, and regulatory laws and statutes.
• Intermediate knowledge of injuries, disability periods, and medical treatment.
• Advanced Workers’ Compensation technical knowledge, including applying available resources and technology and working within the jurisdictional requirements of the assigned state.
• Ability to build productive relationships with insureds and deliver effective customer service.
• Ability to work collaboratively in interdependent teams.
• Advanced planning and organizing skills.

Nice To Haves

• Ability to effectively present claim-file resolutions to internal and external stakeholders.
• Experience with complex Workers’ Compensation claims, litigation, Medicare Set Asides, structured settlements, and mentoring Claim Professionals.

Responsibilities

• Investigate claims by assessing policy coverage and contacting insureds, injured workers, medical providers, and other parties to determine compensability.
• Establish and update reserves to reflect claim exposure, document the rationale, identify actuarial reserves, and assess causal relationships between medical conditions and claims.
• Manage claim files with timely contact, complete documentation, proactive resolution of outstanding issues, and appropriate file closure or reassignment.
• Develop strategies for losses involving statutory benefit entitlement, medical diagnoses, and Medicare Set Asides, working with medical and legal specialists to pursue resolution options.
• Coordinate medical services and claim strategy with internal nurse resources, including Medical Case Managers.
• Prepare required letters and state filings within statutory limits and pursue offset opportunities, including apportionment, contribution, and subrogation.
• Evaluate claims for potential fraud.
• Manage moderate to complex litigation and pursue optimal outcomes, including resolution of benefits; understand and apply Medicare Set Asides and allocations.
• Negotiate claim settlements within designated authority and use structured settlements or annuities when appropriate for the jurisdiction.
• Apply technical expertise to resolve complex claims and act as a technical resource and mentor to other Claim Professionals.
• Participate in telephonic or onsite file reviews, respond to verbal and written inquiries, and keep injured workers apprised of claim status.
• Engage specialty resources as needed and perform other assigned duties, including potentially managing sensitive or complex account relationships or a specialized Workers’ Compensation inventory.
• Obtain and maintain required insurance licenses and complete continuing education as mandated.

Benefits

• Health insurance coverage for employees and eligible family members beginning on the first day of employment.
• Dollar-for-dollar 401(k) matching on contributions up to the first 5% of eligible pay, subject to an annual maximum.
• Paying it Forward Savings Program, which provides an annual 401(k) contribution when an employee makes a student loan payment.
• Pension Plan funded 100% by Travelers.
• A minimum of 20 days of paid time off annually.
• Nine paid company holidays.
• Wellness program with tools, discounts, resources, and caregiving support.
• Mental health program offering 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