Workers Compensation Critical Claim Specialist

Claims Management Position

Under limited supervision, effectively evaluate and manage high exposure Workers Compensation claims including catastrophic loss, specified serious injury and other complex claims. Attempt to resolve through innovative and expert claim management.

This work may include: Remains out of work and unlikely to return to position. Employer is unable to accommodate the restrictions. Injured Worker (IW) has returned to work, reached Maximum Medical Improvement (MMI), and has PPD. File litigated to dispute the permanency rating and/or causality. IW has been released to work with permanent restrictions and job is no longer available. IW is receiving Vocational Rehabilitation. Claims that have been reopened for additional medical treatment on more complex files. Injuries may involve one or multiple back, shoulder or knee surgeries, knee replacements, claims involving complex offsets, permanent restrictions and/or fatalities. Claims on which a settlement should be considered.

Responsibilities

• Claim Handling:
• Work in collaboration with specialty resources (e.g. medical, legal) to manage medical treatment and lost time benefits in cases involving extremely complex issues or potentially high financial exposure.
• Establish and update reserves to reflect claim exposure and document rationale. Identify and set actuarial reserves.
• Develop strategies to manage losses involving complex issues of statutory benefit entitlement, medical diagnoses, Medicare Set Aside or injury severity to achieve resolution through the best possible outcome.
• Co-manage appropriate claims with the Major Case Unit, who will assist with disability and treatment projections; reserving; and investigative suggestions on complex or catastrophic losses.
• May use structured settlement/annuity as appropriate for the jurisdiction.
• Facilitate timely claim resolution by leveraging any mitigation opportunities.
• Influence and Communication:
• Pursue all offset opportunities, including apportionment, contribution and subrogation.
• 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.
• Other Accountabilities:
• Act as technical resource to others.
• Maintain Continuing Education requirements as required.
• 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.

Qualifications

• College degree.
• 5+ years Workers Compensation experience.
• 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: Master evaluation, negotiation and case resolution skills.
• Ability to understand alternatives, influence stakeholders and reach a fair agreement through discussion and compromise.
• Thorough 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: Advanced 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: Thorough 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 establishes a plan/course of action and contingencies for self or others to meet current or future goals.

Must Have

• High school diploma or equivalent.
• 5 years Workers Compensation experience.

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.

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 are a candidate and 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.

To learn more about our comprehensive benefit programs please visit