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Company

Original Job Post

Travelers · 6 days ago

Workers Compensation Claim Analyst

Richardson, TX

Full-time

Hybrid

Entry, Mid Level

$46K/yr - $76K/yr

1+ years exp

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Responsibilities

Manage and resolve stable lifetime claims.

May use structured settlement/annuity as appropriate for the jurisdiction.

Manage existing offsets, including apportionment, contribution and subrogation.

Facilitate timely claim resolution by leveraging any mitigation opportunities.

Establish and update reserves to reflect claim exposure and document rationale.

Work in collaboration with specialty resources (i.e. medical and legal) to proactively pursue claim resolution opportunities, (i.e., structured settlement, discontinuation of benefits through litigation). Collaborate with our internal nurse resources (Medical Case Manager) in order to integrate the delivery of medical services into the overall claim strategy.

Apply knowledge to determine causal relatedness of medical conditions.

Negotiate settlement of claims within designated authority.

Proactively manage inventory with documented plans of action to ensure timely and appropriate file closure or reassignment.

Manage cases telephonically with an emphasis on maximizing quality and controlling costs through aggressive case resolution.

Review, approve and issue accurate and timely indemnity, medical and expense payments for lifetime/long-term claims.

Determine Value of Claim.

Complete required letters and state forms and any other documents as required.

Establish and maintain incurreds which reflect the exposure of the claim, and document a clear reserve rationale.

Apply coverage (limits, endorsements).

Determine and apply offset/contribution from 3rd party, second injury fund, liens, etc.

Develop and Execute Resolution Strategy.

Determine and actively develop ongoing strategic plans for resolution as required and when a significant event impacts the claim.

Utilize and manage resources as necessary to resolve outstanding issues.

Communicate and complete denials on medical and indemnity issues.

Manage inventory to ensure timely file closing or timely reassignment if necessary.

Settlement Evaluation and Negotiation.

Evaluate and document a detailed settlement analysis, value and range within settlement authority.

Execute negotiation strategy and communicate status.

Identify and evaluate the need for Allocation or Medicare Set Aside and make appropriate referral.

Customer Engagement.

Participate in Telephonic and/or onsite File Reviews.

Respond to inquiries - verbal and written.

Keeping injured worker apprised of claim status.

Engage specialty resources as needed.

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.

Perform other duties as assigned.

Qualification

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Working Insurance Contract KnowledgePrinciples of InvestigationValue DeterminationSettlement TechniquesLegal KnowledgeMedical KnowledgeWC TechnicalAnalytical ThinkingCommunicationNegotiationTeamworkCustomer ServicePlanning & OrganizingInsurance License MaintenanceContinuing Education Compliance

Required

High School Diploma or GED and one year of customer service experience OR Bachelors Degree required

College degree highly 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: Basic ability to understand alternatives, influence stakeholders and reach a fair agreement through discussion and compromise

Working 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: Introductory 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: Basic ability to determine liability and assigns a dollar value based on damages claimed and estimates, sets and readjusts reserves

Settlement Techniques: Basic 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: Working 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: Working knowledge of the nature and extent of injuries, periods of disability, and treatment needed. Understanding of when to utilize a medical resource is needed

WC Technical: Basic 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: Intermediate ability to establish a plan/course of action and contingencies for self or others to meet current or future goals