Workers Compensation Claim Specialist, Management

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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 170 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.

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.

$47,700.00 - $78,600.00

2

Under moderate supervision, manage Workers' Compensation Claims with:
Stable Lifetime Indemnity and/or Medical Benefits where the medical expenditures are not expected to exceed $6,000 annually and there are settlement opportunities. Death Benefits, payment of award only, minimal active/pending litigation, including mediation.

As part of the hiring process, this position requires the completion of an online pre-employment assessment. Further information regarding the assessment including an accommodation process, if needed, will be provided at such time as your candidacy is deemed appropriate for further consideration.

• 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 incurrreds 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…