Workers Compensation Claim Representative, Experienced

Travelers•Downers Grove, IL

1d•$67,000 - $110,600

About The Position

The Workers Compensation Claim Representative manages workers’ compensation claims involving lost time through conclusion and negotiates settlements when appropriate. The role independently handles claims of low to moderate complexity, including claims involving wage loss, modified or full-duty return to work, maximum medical improvement (MMI), permanent partial disability (PPD), and ongoing medical treatment. With close to moderate supervision, the representative may also handle more complex claims involving extended time away from work, litigation, permanent restrictions, vocational rehabilitation, reopened claims, multiple surgeries, offsets, fatalities, or potential settlements. The representative coordinates the medical and indemnity aspects of claims with Medical Case Managers and other internal and external resources. The position requires investigation and evaluation of coverage, compensability, medical causation, reserves, benefits, and settlement options. The representative maintains accurate, timely claim files; pursues return-to-work and other resolution strategies; manages litigation; completes required letters and state filings; and negotiates settlements within designated authority. Insurance licenses may be required and generally must be obtained within three months of starting, with continuing education maintained as required. Travelers offers a comprehensive compensation and benefits program, including eligibility for performance-based cash incentive awards. The salary range is $67,000 to $110,600 annually, with actual pay based on factors such as role scope, complexity, location, skills, education, training, credentials, and experience.

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 license(s) if required to comply with state and Travelers requirements; licenses generally must be obtained within three months of starting.

Nice To Haves

2 years of workers’ compensation claim handling experience.
Analytical thinking skills, including identifying problems and opportunities, analyzing information, understanding cause-and-effect relationships, and exploring solutions.
Clear and concise oral and written communication skills.
Ability to present file resolutions effectively to internal and external stakeholders.
Intermediate negotiation skills, including understanding alternatives, influencing stakeholders, and reaching fair agreements.
General insurance contract knowledge, including applying loss facts to policy conditions and determining whether a loss is covered.
Intermediate investigative skills, including taking statements and following a logical sequence of inquiry.
Intermediate ability to determine liability and assign claim values, set reserves, and readjust reserves.
Intermediate knowledge of settlement techniques and settlement offer considerations.
General knowledge and application of applicable laws, statutes, rules of evidence, trial preparation, discovery, court proceedings, and insurance regulations.
Intermediate medical knowledge relating to injuries, disability periods, and treatment.
Intermediate understanding of workers’ compensation products and use of available resources and technology to resolve claims.
Ability to work within jurisdictional parameters for the assigned state.
Advanced customer service skills and ability to maintain productive relationships with insureds.
Advanced teamwork skills in situations involving interdependent actions and shared responsibility.
Advanced planning and organizing skills, including establishing plans and contingencies to meet goals.

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 reserves to reflect claim exposure, document the rationale, identify and set actuarial reserves, and evaluate causal relatedness of medical conditions.
Manage claim files with attention to quality, timely contact, proper documentation, and proactive resolution of outstanding issues.
Coordinate appropriate medical treatment and pursue return-to-work outcomes, collaborating with internal nurse resources when appropriate.
Work with medical and legal specialty resources to pursue resolution opportunities, including return to work, structured settlements, and discontinuation of benefits through litigation.
Develop strategies for losses involving statutory benefit entitlement, medical diagnoses, and Medicare Set Asides.
Collaborate with Medical Case Managers to integrate medical services into the overall claim strategy.
Prepare required letters and state filings within statutory limits.
Pursue offset opportunities, including apportionment, contribution, and subrogation, and evaluate claims for potential fraud.
Manage claim inventory with 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 insurance licenses and continuing education when required.
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) matching on contributions up to the first 5% of eligible pay, subject to an annual maximum.
Paying it Forward Savings Program, with an annual Travelers contribution to the employee’s 401(k) when the 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 with access to free professional counseling, health coaching, and other resources.
Matching Gift and Volunteer Rewards program.
Performance-based cash incentive awards.