Claim Representative

3 weeks ago


GondrecourtleChâteau, Grand Est, United States Travelers Insurance Full time
Job Title: Claim Representative

At Travelers Insurance, we are seeking a skilled Claim Representative to join our team. As a Claim Representative, you will be responsible for managing and resolving workers' compensation claims in a timely and efficient manner.

Key Responsibilities:
  • Manage and resolve stable lifetime claims
  • Use structured settlement/annuity as appropriate for the jurisdiction
  • 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
  • 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 documents as required
  • Establish and maintain incurreds which reflect the exposure of the claim, and document a clear reserve rationale
  • Apply coverage (limits, endorsements)
  • Determine and apply offset/contribution from 3rd party, second injury fund, liens, etc.
  • Develop and execute resolution strategy
  • 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
  • Settlement evaluation and negotiation
  • Evaluate and document a detailed settlement analysis, value, and range within settlement authority
  • Execute negotiation strategy and communicate status
  • Identify and evaluate the need for allocation or Medicare Set Aside and make appropriate referral
  • 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
Requirements:
  • College degree highly preferred
  • Analytical thinking
  • Communication
  • Negotiation
  • Working insurance contract knowledge
  • Principles of investigation
  • Value determination
  • Settlement techniques
  • Legal knowledge
  • Medical knowledge
  • WC technical
  • Customer service
  • Teamwork
  • Planning and organizing
What's in it for you?
  • Health insurance
  • Retirement
  • Paid time off
  • Wellness program
  • Volunteer encouragement


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