Workers Compensation Claim Representative

Who Are We?

Taking care of our customers, our communities and each other. That’s the Travelers Promise. By honoring this commitment, we have maintained our reputation as one of the best property casualty insurers in the industry for over 160 years. Join us to discover a culture that is rooted in innovation and thrives on collaboration. Imagine loving what you do and where you do it.

Compensation Overview

The annual base salary range provided for this position is a nationwide market range and represents a broad range of salaries for this role across the country. The actual salary for this position will be determined by a number of factors, including the scope, complexity and location of the role; the skills, education, training, credentials and experience of the candidate; and other conditions of employment. As part of our comprehensive compensation and benefits program, employees are also eligible for performance-based cash incentive awards.

Salary Range

$65,200.00 - $107,600.00

Target Openings

1

What Is the Opportunity?

Under moderate supervision, investigate compensability of questionable Workers Compensation claims, manage 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.

This work may include: Remains out of work and unlikely to return to position. Employer is unable to accommodate the restrictions. Injured Worker(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.

Travelers offers a hybrid work location model that is designed to support flexibility.

What Will You Do?

• Conduct investigations on non-questionable/questionable claims, including, but not limited to 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.
• Achieve a positive end result by returning injured party to work and coordinating the appropriate medical treatment in collaboration with our internal nurse resources where appropriate.
• If controverted or coverage is unconfirmed, retain and manage assigned claims to conclusion.
• Prepare necessary letters and state filings within statutory limits.
• Proactively manage inventory with documented plans of action to ensure timely and appropriate file closing or reassignment.
• Facilitate timely claim resolution by leveraging any mitigation opportunities.
• Manage litigation to drive files to an optimal outcome.
• Understand and apply Medicare Set Asides and allocations.
• Negotiate settlement of claims within designated authority. May use structured settlement/annuity as appropriate for the jurisdiction.
• Pursue all offset opportunities, including apportionment, contribution and subrogation.
• Evaluate claims for potential fraud.
• Customer Engagement.
• Participate in Telephonic and/or onsite File Reviews.
• Respond to inquiries - verbal and written.
• Keeping injured worker apprised of claim status.
• May handle Critical Claims as outlined below:
• Work in collaboration with specialty resources (e.g. medical, legal) to manage medical treatment and lost time benefits in cases involving extremely complex issues or potentially high financial exposure.
• Develop strategies to manage losses involving complex issues of statutory benefit entitlement, medical diagnoses, Medicare Set Aside or injury severity to achieve resolution through the best possible outcome.
• Co-manage appropriate claims with the Major Case Unit, who will assist with disability and treatment projections; reserving; and investigative suggestions on complex or catastrophic losses.
• Engage specialty resources as needed.
• Act as technical resource to others.
• In order to perform the essential functions of this job, acquisition and maintenance of Insurance License(s) may be required to comply with state and Travelers requirements. Generally, license(s) must be obtained within three months of starting the job and obtain ongoing continuing education credits as mandated.
• Maintain Continuing Education requirements as required.
• Other duties as assigned.
• Perform other duties as assigned.

What Will Our Ideal Candidate Have?

• College degree preferred.
• 3+ years Workers Compensation claim handling experience preferred.
• Analytical Thinking: Identifies current or future problems or opportunities; analyzes, synthesizes and compares information to understand issues; identifies cause/effect relationships; and explores alternative solutions that support sound decision-making.
• Communication: Expresses, summarizes and records thoughts clearly and concisely orally and in writing by applying proper content, format, sentence structure, grammar, language and terminology. Ability to effectively present file resolution to internal and/or external stakeholders.
• Negotiation: Advanced evaluation, negotiation and case resolution skills. Ability to understand alternatives, influence stakeholders and reach a fair agreement through discussion and compromise.
• Thorough Insurance Contract Knowledge: Interprets policies and contracts, applies loss facts to policy conditions, and determines whether or not a loss comes within the scope of the insurance contract.
• - Principles of Investigation: Intermediate investigative skills including the ability to take statements. Follows a logical sequence of inquiry with a goal of arriving at an accurate reconstruction of events related to the loss.
• Value Determination: Advanced ability to determine liability and assigns a dollar value based on damages claimed and estimates, sets and readjusts reserves.
• Settlement Techniques: Intermediate ability to assess how a claim will be settled, when and when not to make an offer, and what should be included in the settlement offer package.
• Legal Knowledge: General knowledge, understanding and application of state, federal and regulatory laws and statutes, rules of evidence, chain of custody, trial preparation and discovery, court proceedings, and other rules and regulations applicable to the insurance industry.
• Medical knowledge: General knowledge of the nature and extent of injuries, periods of disability, and treatment needed.
• WC Technical:
• Intermediate ability to demonstrate understanding of WC Products and ability to apply available resources and technology to resolve claims. Demonstrate a clear understanding and ability to work within jurisdictional parameters within their assigned state.
• Customer Service:
• Advanced ability to build and maintain productive relationships with our insureds and deliver results with optimal outcomes
• Teamwork:
• Advanced ability to work together in situations when actions are interdependent and a team is mutually responsible to produce a result
• Planning & Organizing:
• Advanced ability to establish a plan/course of action and contingencies for self or others to meet current or future goals

What is a Must Have?

• High school diploma or equivalent required.
• Minimum of 2 years Workers Compensation claim handling experience.

What Is in It for You?

• Health Insurance: Employees and their eligible family members – including spouses, domestic partners, and children – 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, subject to an annual maximum. If you have student loan debt, you can enroll in the Paying it Forward Savings Program. When you make a payment toward your student loan, Travelers will make an annual contribution into your 401(k) account. You are also eligible for a Pension Plan that is 100% funded by Travelers.
• 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 is comprised of tools and resources that empower you to achieve your wellness goals. In addition, our Life Balance program provides access to professional counseling services, life coaching and other resources to support your daily life needs. Through Life Balance, you’re eligible for five free counseling sessions with a licensed therapist.
• Volunteer Encouragement: We have a deep commitment to the communities we serve and encourage our employees to get involved. Travelers has a Matching Gift and Volunteer Rewards program that enables you to give back to the charity of your choice.

Employment Practices

Travelers is an equal opportunity employer. We believe that we can deliver the very best products and services when our workforce reflects the diverse customers and communities we serve. We are committed to recruiting, retaining and developing the diverse talent of all of our employees and fostering an inclusive workplace, where we celebrate differences, promote belonging, and work together to deliver extraordinary results.

If you are a candidate and have specific questions regarding the physical requirements of this role, please send us an email so we may assist you.

Travelers reserves the right to fill this position at a level above or below the level included in this posting.

To learn more about our comprehensive benefit programs please visit http://careers.travelers.com/life-at-travelers/benefits/.