Workers Compensation Benefit Management Case Manager

2 weeks ago

Lake Oswego OR, United States The Travelers Companies, Inc. Full time

Taking care of our customers, our communities and each other. By honoring this commitment, we have maintained our reputation as one of the best property casualty insurers in the industry for over 160 years. Join us to discover a culture that is rooted in innovation and thrives on collaboration. 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 skills, education, training, credentials and experience of the candidate; As part of our comprehensive compensation and benefits program, employees are also eligible for performance-based cash incentive awards.
Target Openings
Under moderate supervision, manage Workers' Compensation claims with: Active Lifetime Indemnity and/or Medical Benefits where the medical expenditures exceed $6,000 annually and there are settlement opportunities. Claims with lifetime medical and the indemnity is capped. Litigation for ongoing benefits/entitlement does not include temporary indemnity benefits.
Experience handling workers compensation claims in Oregon and/or Washington is strongly preferred.
Manage and resolve those claims where pre-injury return to work is unlikely.
May use structured settlement/annuity as appropriate for the jurisdiction.
Develop strategies to manage losses involving complex issues of statutory benefit entitlement, medical diagnoses, Medicare Set Aside to achieve resolution through the best possible outcome.
Manage litigation to drive files to an optimal outcome, including discontinuation of benefits.
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 required documents as required.
Establish and maintain incurreds which reflect the exposure of the claim, and document a clear reserve rationale.
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.
Evaluate and document a detailed settlement analysis, value and range within settlement authority.
Keeping injured worker apprised of claim status.
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. 2+ years Workers Compensation claim handling experience preferred.
Experience handling workers compensation claims in Oregon and/or Washington is strongly preferred.
Expresses, summarizes and records thoughts clearly and concisely orally and in writing by applying proper content, format, sentence structure, grammar, language and terminology. Working 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.
Intermediate ability to determine liability and assigns a dollar value based on damages claimed and estimates, sets and readjusts reserves.
Intermediate 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: General 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: General knowledge of the nature and extent of injuries, periods of disability, and treatment needed. Knowing available medical resources and when to utilize these resources.
Intermediate ability to demonstrate understanding of WC Products and ability to apply available resources and technology to resolve claims. Minimum of 1 year Workers Compensation claim handling experience or successful completion of the WC trainee program required.
Employees and their eligible family members – including spouses, domestic partners, and children – are eligible for coverage from the first day of employment.
Retirement: 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.
Volunteer Encouragement: We have a deep commitment to the communities we serve and encourage our employees to get involved. Employees and their eligible family members – including spouses, domestic partners, and children – are eligible for coverage from the first day of employment.
Retirement: 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.
Volunteer Encouragement: We have a deep commitment to the communities we serve and encourage our employees to get involved. We believe that we can deliver the very best products and services when our workforce reflects the diverse customers and communities we serve. We are committed to recruiting, retaining and developing the diverse talent of all of our employees and fostering an inclusive workplace, where we celebrate differences, promote belonging, and work together to deliver extraordinary results.
In accordance with local law, candidates seeking employment in Colorado are not required to disclose dates of attendance at or graduation from educational institutions.

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