Workers Compensation Claim Representative

Job Overview We are seeking an experienced Workers' Compensation claims professional to manage claims of varying complexity, from resourcing lost time to negotiating settlements and coordinating medical and indemnity positions with Medical Case Managers. The role requires close collaboration with insurance, medical, and legal resources to resolve claims efficiently and achieve favorable outcomes for injured workers and the company. Responsibilities Conduct investigations, including assessing policy coverage and contacting insureds, injured workers, medical providers, and other parties to determine compensability. Establish and update reserves, set actuarial reserves, and document reserve rationale. Apply knowledge to determine causal relatedness of medical conditions. Manage files with an emphasis on quality, including timely contact, proper documentation, and proactive resolution of outstanding issues. Achieve a positive end result by returning injured parties to work and coordinating appropriate medical treatment through collaboration with internal nurse resources. Work with specialty resources (medical and legal) to pursue claim resolution opportunities such as structured settlement, return to work, and benefit discontinuation through litigation. Develop strategies to manage losses involving statutory benefit entitlement, medical diagnoses, Medicare Set-Aside, and other complex offsets. Collaborate with internal nurse resources to integrate medical service delivery 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 action plans 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 settlements within designated authority and use structured settlement/annuity when appropriate. Acquire and maintain necessary insurance licenses as required by state and Travelers requirements. Perform other duties as assigned. Qualifications Minimum 2 years of Workers' Compensation claim handling experience. High School Diploma or GED. 1 year of Workers' Compensation claim handling experience or successful completion of the WC trainee program. Analytical Thinking: Identify problems, analyze information, and explore alternative solutions. Communication: Express, summarize, and record thoughts clearly orally and in writing. Negotiation: Intermediate ability to influence stakeholders and reach fair agreements. General Insurance Contract Knowledge: Interpret policies and contracts, and determine coverage limits. Principles of Investigation: Intermediate investigative skills and accurate reconstruction of events. Value Determination: Assess liability and assign dollar values to claims. Settlement Techniques: Evaluate settlement timing and offer components. Legal Knowledge: Understand state, federal, and regulatory laws, evidence rules, and insurance industry regulations. Medical Knowledge: Understand injury nature, disability periods, and treatment needs. WC Technical: Apply Workers' Compensation products and available technology to resolve claims. Customer Service: Build and maintain productive relationships with insureds. Teamwork: Work collaboratively to achieve results when tasks are interdependent. Planning & Organizing: Establish plans and contingencies to meet goals. Maintain Continuing Education requirements and license renewals as mandated. Benefits Health Insurance: Coverage for employees and eligible family members, including spouses, domestic partners, and children, from the first day of employment. Retirement: 401(k) matching dollar-for-dollar up to 5% of eligible pay. Percent match for student loan payments into the 401(k) during the Paying it Forward Savings Program. Pension Plan: 100% funded by Travelers. Paid Time Off: Minimum of 20 days PTO annually plus nine paid company holidays. Wellness Program: Tools, discounts, and resources to support wellness goals and caregiving needs. Mental Health Program: Access to free professional counseling, health coaching, and related resources. Volunteer Encouragement: Matching Gift and Volunteer Rewards program for charitable contributions. Employment Practices Travelers is an equal opportunity employer. We value the unique abilities and talents each individual brings to our organization and recognize that we benefit in numerous ways from our differences. In accordance with local law, candidates seeking employment in Colorado are not required to disclose dates of attendance at or graduation from educational institutions. If you have specific questions regarding the physical requirements of this role, please send us an email so we may assist you. Travelers reserves the right to fill this position at a level above or below the level included in this posting. For more information about our comprehensive benefit programs, visit #J-18808-Ljbffr