Clinical Utilization Review Specialist

6 days ago


Buffalo, New York, United States The Travelers Companies Full time

Welcome to The Travelers Companies, a leading property casualty insurer with over 160 years of experience in delivering innovative solutions to our customers. We are committed to taking care of our customers, communities, and each other, which is reflected in our company promise.

Our Clinical Utilization Review Specialist - Workers Compensation will play a crucial role in ensuring that medical treatment for workers compensation claims is reasonable, necessary, and causally related to the compensable injury. This position requires strong clinical knowledge, critical thinking, and excellent communication skills to interpret medical information, evaluate treatment plans, and negotiate with healthcare providers.

We offer a competitive annual salary range of $83,910 to $139,400, depending on location, experience, and qualifications. Our comprehensive benefits package includes health insurance, retirement plans, paid time off, and wellness programs.

Key responsibilities include:

  • Interpreting routine, complex, or unique medical information to determine medical necessity
  • Evaluating medical treatment to ensure it is reasonable, necessary, and causally related to the compensable injury
  • Submitting accurate billing documentation and engaging specialty resources as needed
  • Utilizing internal Claim Platform Systems to manage claim activities and Preferred Provider Network per jurisdictional guidelines
  • Researching medical information to support claim review processes and occasional contact with providers to ensure injured employees are actively participating in viable treatment plans

To succeed in this role, you will need:

  • A Registered Nurse (RN), Licensed Practical Nurse (LPN), or Licensed Vocational Nurse (LVN) license required
  • Working knowledge of medical causation, jurisdiction-specific medical guidelines, and URAC standards preferred
  • Prior clinical experience and intermediate medical knowledge of injuries, periods of disability, and treatment
  • Excellent customer service, planning, organizing, analytical thinking, and communication skills

We strive to create an inclusive workplace where diversity is celebrated and everyone feels valued. If you're passionate about delivering exceptional patient care and working collaboratively with healthcare professionals, we encourage you to apply for this exciting opportunity.



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