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Travelers · 3 months ago

Senior Workers Compensation Claim Representative

VA - Richmond

Full-time

Hybrid

Mid, Senior Level

$65K/yr - $108K/yr

1+ years exp

Travelers is a leading property casualty insurer with a strong commitment to customer care and community support. They are seeking a Senior Workers Compensation Claim Representative to manage and resolve Workers' Compensation claims, ensuring effective communication and coordination with various stakeholders to achieve optimal outcomes for injured workers. The role involves conducting investigations, negotiating settlements, and collaborating with medical resources to facilitate the return to work for injured parties.

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Growth Opportunities

Responsibilities

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

With close to moderate supervision, may handle claims of greater complexity 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 there has been a change in the current position

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

Conduct investigations, 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

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 where appropriate

Work in collaboration with specialty resources (i.e. medical and legal) to proactively pursue claim resolution opportunities, (i.e. return to work, structured settlement, and discontinuation of benefits through litigation)

Develop strategies to manage losses involving issues of statutory benefit entitlement, medical diagnoses, Medicare Set Aside to achieve resolution through the best possible outcome

Collaborate with our internal nurse resources (Medical Case Manager) in order to integrate the delivery of medical services into the overall claim strategy

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

Effectively manage litigation to drive files to an optimal outcome, including resolution of benefits

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

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

Perform other duties as assigned

Qualification

Workers Compensation claimsAnalytical ThinkingNegotiationGeneral Insurance KnowledgeLegal KnowledgeMedical KnowledgeCustomer ServicePlanning & OrganizingTeamwork

Required

High School Diploma or GED required

Minimum of 1 year Workers Compensation claim handling experience or successful completion of the WC trainee program required

2 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: Intermediate ability to understand alternatives, influence stakeholders and reach a fair agreement through discussion and compromise

General 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: Intermediate 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: Intermediate 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

Maintain Continuing Education requirements as required or as mandated by state regulations

Benefits

Health Insurance

Retirement: Travelers matches your 401(k) contributions dollar-for-dollar up to your first 5% of eligible pay, subject to an annual maximum.

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, discounts and resources that empower you to achieve your wellness goals and caregiving needs.

Volunteer Encouragement: We have a deep commitment to the communities we serve and encourage our employees to get involved.