Workers Compensation Claim Representative, Experienced

Travelers • Chicago, IL

2d

About The Position

Manage Workers’ Compensation claims with lost time through conclusion and negotiate settlements when appropriate. Independently handle assigned claims of low to moderate complexity, including claims involving wage loss, modified or full-duty return-to-work plans, medical treatment, maximum medical improvement (MMI), permanent partial disability (PPD), and minor to moderate litigation. With close to moderate supervision, may also handle more complex claims involving extended time away from work, accommodation or permanent restrictions, vocational rehabilitation, reopened medical treatment, surgery, complex litigation or offsets, fatalities, and potential settlements.

The role involves coordinating the medical and indemnity position of claims with a Medical Case Manager and collaborating with internal nursing, medical, legal, and other specialty resources to develop claim strategies and achieve appropriate resolution. Insurance licenses may be required and generally must be obtained within three months of starting, with ongoing continuing education as mandated. Other duties may be assigned.

Requirements

• High school diploma or GED.
• At least 1 year of Workers’ Compensation claim handling experience or successful completion of the WC trainee program.
• Maintain continuing education requirements as required or mandated by state regulations.
• Obtain and maintain insurance licenses if required by state and Travelers requirements; licenses generally must be obtained within three months of starting.
• Analytical thinking and sound decision-making.
• Clear, concise oral and written communication, including presenting file resolutions to stakeholders.
• Intermediate negotiation skills.
• Knowledge of insurance contracts and policy conditions.
• Intermediate investigative skills, including taking statements and following a logical sequence of inquiry.
• Intermediate ability to determine liability, value damages, and set or adjust reserves.
• Intermediate knowledge of settlement techniques.
• General knowledge of applicable legal and regulatory matters, including statutes, evidence, litigation preparation, discovery, and court proceedings.
• Intermediate medical knowledge concerning injuries, disability periods, and treatment.
• Intermediate Workers’ Compensation technical knowledge and ability to use relevant resources and technology.
• Ability to understand and work within the jurisdictional parameters of the assigned state.
• Advanced customer-service, teamwork, and planning and organizing skills.

Nice To Haves

• 2 years of Workers’ Compensation claim handling experience.
• Intermediate ability to assess settlement options and determine when and how to make an offer.

Responsibilities

• Investigate claims by assessing policy coverage and timely contacting insureds, injured workers, medical providers, and other parties to determine compensability.
• Establish and update reserves to reflect claim exposure, identify actuarial reserves, and document the rationale.
• Determine causal relatedness of medical conditions.
• Manage files for quality through timely contact, proper documentation, and proactive resolution of outstanding issues.
• Coordinate appropriate medical treatment and return-to-work outcomes in collaboration with internal nurse resources.
• Collaborate with medical, legal, and other specialty resources to pursue claim resolution opportunities, including return to work, structured settlements, and discontinuation of benefits through litigation.
• Develop strategies for statutory benefit entitlement, medical diagnoses, Medicare Set Asides, and other issues to achieve appropriate resolution.
• Prepare necessary letters and state filings within statutory limits.
• Pursue offset opportunities, including apportionment, contribution, and subrogation.
• Evaluate claims for potential fraud.
• Proactively manage inventory through documented action plans to support timely and appropriate file closing or reassignment.
• Manage litigation to drive files toward 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.
• Obtain and maintain required insurance licenses and continuing education credits, as applicable.
• Perform other duties as assigned.

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 contributions to an employee’s 401(k) when the employee makes student loan payments.
• A pension plan funded 100% by Travelers.
• A minimum of 20 days of paid time off annually and nine paid company holidays.
• Wellness tools, discounts, and resources, including access to free professional counseling services, health coaching, and other resources.
• Matching Gift and Volunteer Rewards program.

What This Job Offers

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