Senior Workers Compensation Claim Representative

Travelers

98d • $65,300 - $107,600

About The Position

Manage Workers' Compensation claims with lost time to conclusion and negotiate settlements where appropriate to resolve claims. Coordinate medical and indemnity position of the claim with a Medical Case Manager. Independently handles assigned claims of low to moderate complexity where Wage loss and the expectation is a return to work to modified or full duty or obtain MMI with no RTW. There are no litigated issues or minor to moderate litigated issues. The claim may involve minor sprains/ minor to moderate surgery. The injured worker is working modified duty and receiving ongoing medical treatment. The injured worker has returned to work, reached Maximum Medical Improvement (MMI) and is receiving PPD benefits. File will close as soon as the PPD is paid out. With close to moderate supervision, may handle claims of greater complexity where Injured worker (IW) remains out of work and unlikely to return to position. Employer is unable to accommodate the restrictions. The claim involves moderate to complex litigation issues IW has returned to work, reached Maximum Medical Improvement (MMI), and has PPD. File litigated to dispute the permanency rating and/or causality. IW has been released to work with permanent restrictions and there has been a change in the current position. IW is receiving Vocational Rehabilitation. Claims that have been reopened for additional medical treatment on more complex files. Injuries may involve one or multiple back, shoulder or knee surgeries, knee replacements, claims involving moderate to complex offsets, permanent restrictions and/or fatalities. Claims on which a settlement should be considered.

Requirements

• High School Diploma or GED required.
• Minimum of 1 year Workers Compensation claim handling experience or successful completion of the WC trainee program required.
• 2 years Workers Compensation claim handling experience preferred.
• Analytical Thinking: Identifies current or future problems or opportunities; analyzes, synthesizes and compares information to understand issues.
• Communication: Expresses, summarizes and records thoughts clearly and concisely orally and in writing.
• Negotiation: Intermediate ability to understand alternatives, influence stakeholders and reach a fair agreement.
• General Insurance Contract Knowledge: Interprets policies and contracts, applies loss facts to policy conditions.
• Principles of Investigation: Intermediate investigative skills including the ability to take statements.
• Value Determination: Intermediate ability to determine liability and assigns a dollar value based on damages claimed.
• Settlement Techniques: Intermediate ability to assess how a claim will be settled.
• Legal Knowledge: General knowledge, understanding and application of state, federal and regulatory laws and statutes.
• Medical knowledge: Intermediate knowledge of the nature and extent of injuries, periods of disability, and treatment needed.
• WC Technical: Intermediate ability to demonstrate understanding of WC Products.

Responsibilities

• Conduct investigations, including assessing policy coverage, contacting insureds, injured workers, medical providers, and other parties in a timely manner to determine compensability.
• Establish and update reserves to reflect claim exposure and document rationale.
• Identify and set actuarial reserves.
• Apply knowledge to determine causal relatedness of medical conditions.
• Manage files with an emphasis on file quality including timely contact and proper documentation and proactive resolution of outstanding issues.
• Achieve a positive end result by returning injured party to work and coordinating the appropriate medical treatment in collaboration with internal nurse resources.
• Work in collaboration with specialty resources to proactively pursue claim resolution opportunities.
• Develop strategies to manage losses involving issues of statutory benefit entitlement, medical diagnoses, Medicare Set Aside.
• Collaborate with internal nurse resources to integrate the delivery of medical services into the overall claim strategy.
• Prepare necessary letters and state filings within statutory limits.
• Pursue all offset opportunities, including apportionment, contribution and subrogation.
• Evaluate claims for potential fraud.
• Proactively manage inventory with documented plans of action to ensure timely and appropriate file closing or reassignment.
• Effectively manage litigation to drive files to an optimal outcome.
• Understand and apply Medicare Set Asides and allocations.
• Negotiate settlement of claims within designated authority.

Benefits

• Health Insurance: Employees and their eligible family members 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.
• 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 provides tools, discounts and resources for wellness goals.
• Volunteer Encouragement: Travelers encourages employees to get involved in the community with a Matching Gift and Volunteer Rewards program.

What This Job Offers

• Job Type: Full-time
• Career Level: Entry Level
• Education Level: High school or GED
• Number of Employees: 5,001-10,000 employees