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Travelers · 2 weeks ago

Workers Compensation Claim Analyst

St Paul, MN

Full-time

Hybrid

Entry Level

$48K/yr - $79K/yr

1+ years exp

Travelers is a well-established property casualty insurer with a commitment to customer care and community service. The Workers Compensation Claim Analyst will manage and resolve stable lifetime claims, ensuring timely claim resolution and collaboration with medical and legal resources.

Auto InsuranceInsuranceProperty Insurance

Growth Opportunities

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

Analytical ThinkingWorking Insurance Contract KnowledgeLegal KnowledgeNegotiationMedical KnowledgeWC TechnicalCustomer ServicePlanning & OrganizingTeamwork

Required

High School Diploma or GED and one year of customer service experience OR Bachelor's Degree

College degree

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

Benefits

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, discounts and resources that empower you to achieve your wellness goals and caregiving needs. In addition, our mental health program provides access to free professional counseling services, health coaching and other resources to support your daily life needs.

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.