Workers Compensation Claim Representative

Travelers • Las Vegas, NV

1d • $65,300 - $107,600

About The Position

Under moderate supervision, the Workers Compensation Claim Representative investigates claims to determine compensability and asserts customers’ legal rights to pay or deny claims. The position does not lead others. The representative conducts initial and complete investigations, manages claims through resolution when they are controverted or coverage is unconfirmed, and reassesses or reassigns claims as appropriate. The role also involves determining coverage and offsets, developing litigation and settlement strategies, evaluating medical causation and claim exposure, and engaging specialty resources when needed.

The representative communicates with injured workers and other parties, responds to written and verbal inquiries, participates in telephonic or onsite file reviews, and works with hearing representatives or defense counsel on litigated claims. Insurance license(s) may be required to meet state and Travelers requirements; generally, licenses must be obtained within three months of starting, with continuing education maintained as required. Other duties may be assigned.

Requirements

• High school diploma or equivalent.
• 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.
• Analytical thinking and sound decision-making skills.
• Clear and concise verbal and written communication skills.
• Ability to present file resolutions effectively to internal and/or external stakeholders.
• Intermediate negotiation skills.
• Thorough insurance contract knowledge.
• Intermediate investigative skills, including ability to take statements.
• Intermediate ability to determine liability, assign claim values, and set and readjust reserves.
• Intermediate settlement techniques.
• General knowledge of applicable legal principles, laws, statutes, rules, and court proceedings.
• General medical knowledge concerning injuries, disability periods, and treatment.
• Intermediate understanding of Workers Compensation products and ability to use available resources and technology to resolve claims.
• Ability to work within jurisdictional parameters for the assigned state.
• Advanced customer service, teamwork, and planning and organizing abilities.

Nice To Haves

• Bachelor's degree.
• 2 years of Workers Compensation claim handling experience.
• Ability to mentor or coach others to improve investigative planning.

Responsibilities

• Conduct initial investigations of claims to resolve compensability, coverage, and offset issues on new notices.
• Retain and manage assigned claims through conclusion when claims are controverted or coverage is unconfirmed.
• Reassign claims appropriately when they are non-controverted and coverage is confirmed.
• Conduct complete investigations of questionable claims, including timely contact with appropriate parties.
• Develop and manage litigation strategy with a Hearing Representative or Defense Counsel on litigated claims.
• Engage specialty resources as needed.
• Establish and update estimates to reflect exposure.
• Develop resolution strategies to negotiate and settle claims.
• Apply knowledge to determine the causal relatedness of medical conditions.
• Interpret Workers Compensation policies and endorsements when making coverage decisions.
• Participate in customer engagement and telephonic and/or onsite file reviews.
• Respond to verbal and written inquiries.
• Keep injured workers apprised of claim status.
• Obtain and maintain required insurance licenses and continuing education, as applicable.
• Perform other duties as assigned.

Benefits

• Health insurance coverage for employees and eligible family members from 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 contributions to an employee’s 401(k) account when the employee makes student loan payments.
• Pension Plan funded 100% by Travelers.
• Minimum of 20 days of paid time off annually.
• Nine paid company holidays.
• Wellness program with tools, discounts, and resources.
• Free professional counseling services, health coaching, and other mental health 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