Primary Job Duties & Responsibilities
Customer Contacts/Experience: 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.
Coverage Analysis : Reviews and analyzes coverage and applies policy conditions, provisions, exclusions and endorsements for moderate complexity Bodily Injury liability claims in assigned jurisdictions.
Verifies the benefits available, the injured party's eligibility and the applicable limits.
Addresses proper application of any deductibles, co-insurance, coverage limits, etc.
Confirms priority of coverage (i.e. primary, secondary, concurrent) and takes into consideration issues such as Social Security, Workers Compensation or others relevant to the jurisdiction.
Consults with Unit Manager on use of Claim Coverage Counsel.
Investigation/Evaluation: 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).
This may also include investigation of wage loss and essential services claims.
Verifies the nature and extent of injury or property damage by obtaining and reviewing appropriate records and damages documentation.
Takes recorded statements as necessary.
Utilizes evaluation documentation tools in accordance with department guidelines.
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.
Reserving: 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.
Negotiation/Resolution: Determines settlement amounts, negotiates and conveys claim settlements within authority limits to claimants or their representatives.
Recognizes and implements alternate means of resolution.
As appropriate, writes denial letters, Reservation of Rights and other necessary correspondence to claimants.
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. Insurance License: 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.
Perform other duties as assigned.
Job Specific & Technical Skills & Competencies
Demonstrated ownership attitude and customer centric response to all assigned tasks Demonstrated good organizational skills with the ability to prioritize and work independently Attention to detail ensuring accuracy Keyboard skills and Windows proficiency, including Excel and Word
Intermediate Verbal and written communication skills
Intermediate Analytical Thinking- Intermediate Judgment/Decision Making- Intermediate Negotiation- Intermediate Insurance Contract Knowledge- Intermediate Principles of Investigation- Intermediate Value Determination- Intermediate Settlement Techniques- Intermediate Medical Knowledge- Intermediate
This position is responsible for handling Personal and Business Insurance Auto Bodily Injury claims from the first notice of loss through resolution/settlement and payment process.
This may include interpreting and applying laws and statutes for multiple state jurisdictions.
Claim types include moderate complexity Bodily Injury claims.
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.
As part of the hiring process, this position requires the completion of an online pre-employment assessment.
Further information regarding the assessment including an accommodation process, if needed, will be provided at such time as your candidacy is deemed appropriate for further consideration.
This job does not manage others.
This job works under General Supervision: Incumbent independently performs a variety of duties, including potentially complex duties within established policy guidelines; responsible for a defined set of assignments (e.g. assigned customers, claims or other specified set of responsibilities); is expected to set priorities and meet specific goals and objectives of the function or unit. (Typically pertains to advanced/operational, senior professional, unit supervisor)
Education, Work Experience & Knowledge
Bachelor's Degree preferred.
2 years bodily injury liability claim handling experience preferred.
General knowledge and skill in claims handling and litigation.
Basic working level knowledge and skill in various business line products.
Operates standard office equipment
Continuously Sitting (can stand at will)
Continuously Use of Keyboards, Sporadic 10-Key
High School Degree or GED with a minimum of one year bodily injury liability claim handling experience or successful completion of Travelers Claim Representative training program is required.
The Travelers Companies