Workers Compensation Senior Claim Representative

Travelers

108d • $68,600 - $113,000

About The Position

Under general supervision, 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. Independently handles all assigned claims up to and including most complex 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 job is no longer available. 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 equivalent required.
• Minimum of 2 years Workers Compensation claim handling experience.

Nice To Haves

• 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: Advanced evaluation, negotiation and case resolution skills.
• 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: Advanced ability to determine liability and assigns a dollar value based on damages claimed.
• Settlement Techniques: Advanced ability to assess how a claim will be settled.
• Legal Knowledge: Thorough knowledge, understanding and application of state, federal and regulatory laws.
• Medical knowledge: Intermediate knowledge of the nature and extent of injuries.
• WC Technical: Advanced ability to demonstrate understanding of WC Products.
• Customer Service: Advanced ability to build and maintain productive relationships.
• Teamwork: Advanced ability to work together in situations when actions are interdependent.
• Planning & Organizing: Advanced ability to establish a plan/course of action.

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.
• Develop strategies to manage losses involving issues of statutory benefit entitlement, medical diagnoses, Medicare Set Aside to achieve resolution through the best possible outcome.
• Work in collaboration with specialty resources to proactively pursue claim resolution opportunities.
• 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.
• Proactively manage moderate to complex litigation to drive files to an optimal outcome.
• Negotiate settlement of claims within designated authority.
• Mentor other Claim Professionals.
• Participate in Telephonic and/or onsite File Reviews.
• Respond to inquiries – verbal and written.
• Keep injured worker apprised of claim status.
• Engage specialty resources as needed.

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 access to free professional counseling services.
• Volunteer Encouragement: Travelers has 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