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Travelers · 1 day ago

Workers Compensation Senior Claim Representative

KS - Overland Park

Full-time

Hybrid

Mid, Senior Level

$70K/yr - $116K/yr

2+ years exp

Travelers is a leading property casualty insurer with a commitment to customer care and community service. They are seeking a Senior Claim Representative to manage Workers' Compensation claims, negotiate settlements, and coordinate with medical professionals to ensure optimal outcomes for injured workers.

Auto InsuranceInsuranceProperty Insurance

Growth Opportunities

Responsibilities

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

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 (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

Proactively manage moderate to complex 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. Apply deep technical expertise to assist in the resolution of highly complex claims. 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

Act as technical resource to others

Participate in Telephonic and/or onsite File Reviews. Respond to inquiries – verbal and written. Keep injured worker apprised of claim status. Act as technical resource to others. Engage specialty resources as needed

Performs other assigned duties which may include: Applies deep technical/subject matter expertise to assist in the resolution of complex claims. Acts as an independent mentor to other Claim Professionals. May be dedicated to and apply skills necessary to manage special account relationships (sensitive or complex). May primarily manage a specialized inventory of Workers’ Compensation claims

Acts as an independent mentor to other Claim Professionals Applies deep technical/subject matter expertise to assist in the resolution of complex claims

Acts as an independent mentor to other Claim Professionals

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

Workers Compensation claimsLegal KnowledgeNegotiationAnalytical ThinkingCustomer ServiceWC TechnicalPlanning & OrganizingPrinciples of InvestigationSettlement TechniquesMedical knowledgeValue DeterminationCommunicationTeamwork

Required

High school diploma or equivalent

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: Advanced evaluation, negotiation and case resolution skills

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

Settlement Techniques: Advanced 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: Thorough 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: Advanced 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