Medical Claims Specialist

3 weeks ago

Morristown, New Jersey, United States Travelers Insurance Full time
Job Summary

We are seeking a skilled Medical Claims Processor to join our team at Travelers Insurance. As a Medical Claims Processor, you will be responsible for handling Personal and Business Insurance Auto Bodily Injury claims from the first notice of loss through resolution/settlement and payment process.

Key Responsibilities
  • Provides quality claim handling throughout the claim life cycle (customer contacts, coverage, investigation, evaluation, reserving, negotiation and resolution) including maintaining full compliance with internal and external quality standards and state specific regulations.
  • Delivers consistent service quality throughout the claim life cycle, including but not limited to prompt contact, explaining the process, setting expectations, on-going communication, follow-through and meeting commitments to achieve optimal outcome on every file.
  • Fulfills specific service commitments made to certain accounts, as outlined in Special Account Communication (SAC) instructions.
  • Reviews and analyzes coverage and applies policy conditions, provisions, exclusions and endorsements for moderate complexity Bodily Injury liability claims in assigned jurisdictions.
  • Addresses proper application of any deductibles, co-insurance, coverage limits, etc. Consults with Unit Manager on use of Claim Coverage Counsel.
  • Investigates each claim to obtain relevant facts necessary to determine coverage, the extent of liability, damages, and contribution potential with respect to the various coverages provided through prompt contact with appropriate parties (e.g. policyholders, accounts, claimants, law enforcement agencies, witnesses, agents, medical providers and technical experts).
  • Identifies resources for specific activities required to properly investigate claims such as Subrogation, Risk Control, nurse consultants, and fire or fraud investigators and to other experts.
  • Requests through Unit Manager and coordinate the results of their efforts and findings.
  • Recognizes cases based on severity protocols to be referred timely to next level claim professional or Major Case Unit.
  • Establishes timely and maintains appropriate claim and expense reserves.
  • Manages file inventory and expense reserves by utilizing an effective diary system, documenting claim file activities in accordance with established procedures to resolve claim in a timely manner.
  • Determines settlement amounts, negotiates and conveys claim settlements within authority limits to claimants or their representatives.
  • Handles both unrepresented and attorney represented claims. May manage litigated claims on appropriately assigned cases.
  • Develops litigation plan with staff or panel counsel, track and control legal expenses. May attend depositions, mediations, arbitrations, pre-trials, trials and all other legal proceedings, as needed.
Requirements
  • Bachelor's Degree preferred.
  • ~2 years bodily injury liability claim handling and/or comparable litigation claim handling experience preferred.
  • ~ General knowledge and skill in claims handling and litigation.
  • ~ Keyboard skills and Windows proficiency, including Excel and Word - Intermediate.
  • ~ Insurance Contract Knowledge- Intermediate.
  • ~ Medical Knowledge- Intermediate.
Benefits
  • Employees and their eligible family members – including spouses, domestic partners, and children – are eligible for coverage from the first day of employment.
  • 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.
  • Start your career at Travelers with a minimum of 20 days Paid Time Off annually, plus nine paid company Holidays.
Company Culture

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.

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