FPM Arbitration Litigation Claim Representative

Who Are We?

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.

$60,800.00 - $

4

This role is eligible for a sign on bonus up to $10,000.

This position handles First Party Medical Litigation or Arbitration claims from the first notice of suit/arbitration to resolution/settlement and payment process. Provides quality claim handling throughout the litigation/arbitration life cycle (attorney/provider contacts, coverage, investigation, evaluation, reserving, negotiation and resolution) including maintaining full compliance with internal and external quality standards and state specific regulations.

• Coverage Analysis:
  Review and analyze coverage and policy conditions, provisions, exclusions and endorsements, and how jurisdictional issues impact the claim. Confirm the benefits available, the injured party's eligibility and the applicable limits. Confirm proper application of any deductibles, coverage limits, etc. Confirm priority of coverage i.e.: primary, secondary, concurrent or not applicable, and take into consideration other issues such as Social Security, Workers Compensation or others relevant to the jurisdiction.
• Investigation/Evaluation:
  Evaluate each suit/arbitration to obtain relevant facts necessary to determine defensibility and potential exposure. Prompt review of claim file and handling procedures to determine validity of the action. Review of current legal/jurisdictional resources and applicable case law in conjunction with Claim counsel and First Party Medical claim professional, if necessary. Proactively manage ongoing litigation/arbitration through prompt, consistent follow up with Claim counsel and other applicable resources.
• Reserving:
  Establish timely and maintain appropriate claim and expense reserves to reflect the overall claim exposure. Manage file inventory and expense reserves by utilizing an effective diary system, documenting claim file activities to resolve claim in a timely manner.
• Negotiation/Resolution:
  Determine settlement amounts, negotiate and convey claim settlements within authority limits to attorneys, providers and claimants. As appropriate, write denial letters, Reservation of Rights and other necessary correspondence to attorneys, providers and claimants. Develop resolution plan with staff or panel counsel, and track and control legal expenses;
  Review conciliations and prepare submissions for arbitration and/or mediation hearings. May also attend arbitrations as Company witness. Attend depositions, mediations, arbitrations, pre-trials, trials and all other legal proceedings, as needed.
• Recognize and engage the appropriate resources (i.e. Nurse, SIU, claim counsel, property, etc.) to move the file towards appropriate resolution. Identify subrogation opportunities, determine appropriateness of the demand and negotiate adverse subrogation and arbitration.
• Recognize cases based on severity protocols to be referred timely to next level claim professional.
• 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.

• Associate's or Bachelor's degree or equivalent business experience.
• Prior First Party Medical and/or litigation claim handling experience.
• Strong keyboard skills and Windows proficiency, including Excel and Word.
• Demonstrated ownership attitude and customer centric response to all assigned tasks.
• Strong verbal and written communication skills.
• Attention to detail ensuring accuracy.
• Ability to work in a high volume, fast paced environment managing multiple priorities.
• Competency Levels:
• Analytical Thinking - Intermediate.
• Judgment/Decision Making - Intermediate.
• Communication - Intermediate.
• Negotiation - Intermediate.
• Insurance Contract Knowledge - Intermediate.
• Principles of Investigation
  - Intermediate.
• Value Determination -…