Workers' Comp Claim Rep Trainee

The Travelers Companies Hunt Valley , MD 21031

Posted 2 months ago

Primary Job Duties & Responsibilities

Completes required training program which includes the overall instruction, exposure, and preparation for employees to progress to the next level position. It is a mix of online, virtual, classroom, and on-the-job training.

The training may require travel. The on the job training includes practice and execution and coaching on the following core assignments: Conduct investigations, including, but not limited to assessing policy coverage, investigation of non-questionable/questionable claims, contacting insureds, injured workers, medical providers, and other parties in a timely manner to determine compensability.

Proactively manage inventory with documented plans of action and emphasis on file quality and data integrity to ensure timely and appropriate resolution or reassignment. Achieve a positive end result by returning injured party to work and coordinating the appropriate medical treatment in collaboration with internal nurse resources where appropriate. Manage, resolve or reassign those claims where pre-injury return to work is unlikely.

Establish and update reserves to reflect claim exposure and document rationale. Identify exposures and establish appropriate reserves. Apply knowledge to determine causal relatedness of medical conditions.

Collaborate with internal nurse resources (Medical Case Manager) in order to integrate the delivery of medical services into the overall claim strategy. Complete required letters and state forms and any other required documents as required. Prepare necessary letters and state filings within statutory limits.

Determine and actively develop ongoing strategic plans for resolution as required. Develop strategies to manage losses involving issues of statutory benefit entitlement, medical diagnoses, Medicare Set Aside to achieve resolution through the best possible outcome. Work in collaboration with specialty resources (i.e. medical and legal) to proactively pursue claim resolution opportunities.

Pursue all offset opportunities, including apportionment, contribution and subrogation. Evaluate claims for potential fraud. Effectively manage litigation to drive files to an optimal outcome, including resolution of benefits.

Understand and apply Medicare Set Asides and allocations. Negotiate settlement of claims within designated authority. Evaluate and document a detailed settlement analysis, value and range.

Refer claims beyond authority as appropriate based on exposure and established guidelines. May use structured settlement/annuity as appropriate for the jurisdiction. Participate in Telephonic and/or onsite File Reviews.

Respond to inquiries - verbal and written. Keeping injured worker apprised of claim status. Communicate and complete denials on medical and indemnity issues.

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. In order to progress to Claim Representative, a Trainee must demonstrate proficiency in the skills outlined above.

Proficiency will be verified by appropriate management, according to established standards. Perform other duties as assigned.

Job Specific & Technical Skills & Competencies

Demonstrated ownership attitude and customer centric response to all assigned tasks

  • Basic Verbal and written communication skills

  • Intermediate Attention to detail ensuring accuracy

  • Basic Ability to work in a high volume, fast paced environment managing multiple priorities

  • Basic Analytical Thinking

  • Basic Judgment/ Decision Making

  • Basic

Job Summary

This is an entry level position that requires satisfactory completion of required training to advance to a Workers' Compensation claim professional position. This position is intended to develop skills for investigating, evaluating, negotiating and resolving claims on losses of lesser value and complexity. 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 Close Supervision: Work is reviewed at several steps along the way. (Generally pertains to trainee positions.)

Education, Work Experience & Knowledge

Bachelor's Degree preferred or a minimum of 2 years of work OR customer service related experience preferred.

Physical Requirements

Operates standard office equipment

  • Frequently Sitting (can stand at will)

  • Frequently Standing

  • Occasionally Use of Keyboards, Sporadic 10-Key

  • Frequently

Minimum Qualifications

High School Diploma or GED and one year of customer service experience OR Bachelor's Degree required.



icon no score

See how you match
to the job

Find your dream job anywhere
with the LiveCareer app.
Mobile App Icon
Download the
LiveCareer app and find
your dream job anywhere
App Store Icon Google Play Icon
lc_ad

Boost your job search productivity with our
free Chrome Extension!

lc_apply_tool GET EXTENSION

Similar Jobs

Want to see jobs matched to your resume? Upload One Now! Remove
RN Medical Case Manager Workers Compensation

The Travelers Companies

Posted 1 week ago

VIEW JOBS 9/5/2019 12:00:00 AM 2019-12-04T00:00 Primary Job Duties & Responsibilities * Contact customer, medical provider and injured parties on claims involving medical treatment and /or disability to coordinate appropriate medical care and return to work. * Develop strategies to facilitate an injured employee's return to work and achieve maximum medical improvement. * Evaluate and update treatment and return to work plans within established protocols throughout the life of the claim. * Coordinate with medical providers to ensure the injured employee is actively participating in a viable treatment plan. * Evaluate medical treatment requests to ensure that they are reasonable and necessary based upon jurisdictional guidelines. Engage specialty resources as needed to achieve optimal resolution (Dial-a-doc, physician advisor, peer reviews, MCU). * Partner with Claim Professional to provide medical information and disability status necessary to create an overall strategy to achieve an optimal outcome. * Utilize internal Claim Platform Systems to manage all claim activities on a timely basis. * Utilize Preferred Provider Network per jurisdictional guidelines. * Partner with Claim Professional to provide input on medical treatment and recovery time to assist in evaluating appropriate claim reserves. * Submit accurate billing documentation on all activities as outlined in established guidelines. * Customer Engagement. Participate in Telephonic and/or onsite File Reviews. * Respond to inquiries - oral and written. * Keep injured worker apprised of claim status. * In-person medical case management may be required to support Concierge locations, where a Nurse Case Manager meets with injured employees face to face following office visits at a provider's medical facility. * 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. Job Specific & Technical Skills & Competencies * Familiarity with URAC standards 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. * General Insurance Contract Knowledge: Ability to understand policies and contracts, as they apply to policy conditions. Principles of Investigation: Intermediate investigative skills. Follows a logical sequence of inquiry with a goal of securing information about the work accident, resulting injury, anticipated treatment, job duties and any material factors that may impact recovery and return to work. * Value Determination: Basic ability to determine liability and assigns a dollar value based on damages claimed and estimates, sets and readjusts reserves. * Legal Knowledge: Basic 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: Thorough 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 manage treatment plans and assist with claim resolution. 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. Job Summary * Under moderate supervision, provide office based telephonic medical case management with emphasis on early intervention, return to work planning, coordination of quality medical care on claims involving disability and medical treatment as well as in-house medical reviews as applicable to claim handling laws and regulations. * Responsible for helping to ensure injured parties receive appropriate treatment directly related to the compensable injury or assist claim handlers in managing medical treatment to an appropriate resolution. * This job does not manage others. * This job works under Moderate Supervision: Incumbent performs standard and routine assignments independently to conclusion; unusual problems which may require exceptions to procedures or processes are referred to the supervisor. * 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. Preferred Qualifications Bilingual candidates strongly encouraged to apply. Education, Work Experience & Knowledge Disability case management experience preferred. Prior clinical experience preferred. RN preferred. Physical Requirements Operates standard office equipment (Continuously) Sitting (can stand at will) (Continuously) Use of Keyboards, Sporadic 10-Key (Continuously) Driving (Occasionally) Minimum Qualifications Registered Nurse; Licensed Practical Nurse or Licensed Vocational Nurse required. The Travelers Companies Hunt Valley MD

Workers' Comp Claim Rep Trainee

The Travelers Companies