Job Description

Primary Job Duties & Responsibilities

Conduct initial investigation of claims to resolve compensability, coverage and offset issues on new notices.
Retain and manage assigned claims to conclusion if controverted or coverage is unconfirmed.
Reassign claims appropriately if non-controverted and coverage is confirmed.
Conduct complete investigation of questionable claims, including timely contact with appropriate parties.
Develop and manage litigation strategy with Hearing Representative or Defense Counsel on litigated claims.
Engage specialty resources as needed.
Establish and update estimates to reflect exposure.
Develop resolution strategies in order to negotiate and settle Claims.
Apply knowledge to determine causal relatedness of medical conditions.
Interpret Workers Compensation policies and endorsements in coverage decisions.
Customer Engagement.
Participate in Telephonic and/or onsite File Reviews.
Respond to inquiries – verbal and written.
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. Generally, license(s) must be obtained within three months of starting the job and obtain ongoing continuing education credits as mandated.

Minimum Qualifications

High school diploma or equivalent required.
Minimum of 1 year Workers Compensation claim handling experience or successful completion of the WC trainee program required.

Education, Work Experience, & Knowledge

Bachelors degree preferred.
2 years Workers Compensation claim handling experience preferred.
Maintain Continuing education requirements as required or as mandated by state regulations.

Job Specific Technical Skills & Competencies

Analytical Thinking: Identifies current or future problems or opportunities; analyzes, synthesizes and compares information to understand issues; identifies cause/effect relationships; and explores alternative solutions that support sound decision-making.
Communication: Expresses, summarizes and records thoughts clearly and concisely orally and in writing by applying proper content, format, sentence structure, grammar, language and terminology. Ability to effectively present file resolution to internal and/or external stakeholders.
Negotiation: Intermediate ability to understand alternatives, influence stakeholders and reach a fair agreement through discussion and compromise.
– Thorough 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.
Principles of Investigation: Intermediate investigative skills including the ability to take statements. Follows a logical sequence of inquiry with a goal of arriving at an accurate reconstruction of events related to the loss. Mentors/coaches others to improve their investigative planning.
Value Determination: Intermediate ability to determine liability and assigns a dollar value based on damages claimed and estimates, sets and readjusts reserves.
Settlement Techniques: 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.
WC Technical:
Intermediate ability to demonstrate understanding of WC Products and ability to apply available resources and technology to resolve claims. Demonstrate a clear understanding and ability to work within jurisdictional parameters within their assigned state.
Customer Service:
Advanced ability to build and maintain productive relationships with our insureds and deliver results with optimal outcomes
Teamwork:
Advanced ability to work together in situations when actions are interdependent and a team is mutually responsible to produce a result
Planning & Organizing:
Advanced ability to establish a plan/course of action and contingencies for self or others to meet current or future goals