Medical Claims

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. Claim
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
Investigate, evaluate, reserve, negotiate and resolve the company's most severe and/or complex Workers Compensation Subrogation claims, in multiple jurisdictions, in accordance with Best Practices. Provide quality claim handling and superior customer service on assigned claims, while engaging in indemnity & expense management. Promptly manage Workers Compensation Subrogation claims by completing essential functions including contacts, investigation, damages development, evaluation, reserving, litigation management, negotiating and resolution. Provides consulting and training and serves as an expert technical resource to other claim professionals, business partners, customers, and other stakeholders as appropriate or required.
This is a hybrid position that can be located out of any Travelers claim office location nationwide.
CLAIM HANDLING:
Directly handle the Company's most severe and complex Workers Compensation Subrogation claims when Travelers has coverage of $2 million or greater and file exposure is greater than $2 million.
Provide quality customer service and ensure file quality timely coverage analysis and communication with insured based on application of policy information to facts or allegations of each case.
Directly investigate each claim through prompt and strategically-appropriate contact with appropriate parties such as policyholders, accounts, claimants, law enforcement agencies, witnesses, agents, medical providers and technical experts to determine the extent of liability, damages, and contribution potential.
or external resources for specific activities required to effectively evaluate claims, such as Risk Control, nurse consultants and fire or fraud investigators and other experts.
Utilize diary management system to ensure that all claims are handled timely.
Share experience and deep knowledge of creative resolution techniques to improve the claim results of others.
Apply the Company's claim quality management protocols, Best Practices and metrics to all claims; document the rationale for any departure from applicable protocols and metrics.
Develop and employ creative resolution strategies.
Evaluate all claims for recovery potential; Responsible for prompt and proper disposition of all claims within delegated authority. Negotiate disposition of claims with insureds and claimants or their legal representatives.
Ensure that the right resources are being applied to each claim to achieve the best result at the most optimal cost.
Actively provide mentoring and coaching to less experienced claim professionals to increase the technical expertise and improve bench strength.
Collaborate with Subrogation Major Case and Recovery Centers in the management and evaluation of some of the Company's severe and complex Subrogation claims by providing claim handling guidance, recommendations and strategies to Regional Directors, Unit Managers, and Major Case Specialists, for timely, cost effective resolution of Subrogation major cases.
Provide mentoring or training as requested by management.
Consult with Manager on use of Claim Coverage Counsel as needed.
Provide guidance to underwriting business partners with resolution accuracy and adequacy of, and potential future changes to, loss reserves on assigned claims.
Update appropriate parties as needed, providing new facts as they become available, and their impact upon the liability analysis and settlement options.
Represent the company as a technical resource, attend legal proceedings as needed, act within established professional guidelines as well as applicable state laws
Obtain and evaluate current information regarding trends in the law; digest and communicate this information to other Company departments and divisions to assist in underwriting and management decisions.
Assist underwriting business partners in marketing and account-contact.
Actively participate in the coverage, liability and damages analysis and development of creative resolution strategy for severity cases handled in Major Case and the Recovery Centers.
Regularly and actively participate in field severity roundtables to share expertise and recommendations in all aspects of severe claim management.
Collaborate with the severity unit in compliance with company claim policies, procedures, practices and standards for the handling of cases that meet the Critical Claim referral guidelines.
Apply expert litigation management through the selection of counsel, evaluation and direction of claim and litigation strategy.
Manages litigated claims. Develop litigation plan with staff or panel counsel, including discovery and legal expenses, to assure effective resolution and to satisfy our customers.
Track and control legal expenses to assure cost-effective resolution.
Develop and employ innovative techniques to manage expense and outcome when independent counsel is engaged.
Attend depositions, mediations, arbitrations, pre-trials, trials and all other legal proceedings, as needed.
Actively participate in periodic file quality reviews.
Appropriately deal with information that is considered personal and confidential.
Fulfill specific service commitments made to certain accounts, as outlined in Special Account Communication (SAC) instructions, and inquiries from agents and brokers.
Occasional travel for mediations, trials
5-10 years experience handling serious injury and complex liability claims preferred (casualty claim operations environment determining coverage, liability, investigation, research, evaluation, negotiation and settlement).
Thorough understanding of product lines, objectives of claim management, and legal theory issues involving claim resolution. Familiarity with commercial lines/personal lines products, policy language, exclusions, ISO forms, effective claims handling practices.
Extensive experience handling large exposure and/or complex liability claims
Familiarity with commercial lines products, policy language, exclusions, ISO forms, effective claims handling practices.
Thorough understanding of the litigation process, relevant case and statutory law.
Expert written and verbal communication skills to understand, synthesize, interpret and convey complex data.
Leading Others - Attract Top Talent, Maximize Individual Performance, Holds Others Accountable, Aligns Rewards, Creates and Sustains a Dynamic Workplace.
Leading Self-Emotional Intelligence - Demonstrates Self-Awareness, Initiative and accountability, Applies Critical Thinking, Communications Effectively & Influences Others, Exhibits Courage, Conviction & Credibility.
5 years bodily injury litigation claim handling experience or 10 years litigation experience required.
In order to perform the essential job functions of this job, acquisition and maintenance of Insurance License(s) may be required to comply with state and Travelers requirements. 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. In accordance with local law, candidates seeking employment in Colorado are not required to disclose dates of attendance at or graduation from educational institutions.