Workers Compensation Claim Analyst

Workers' Compensation Claims Manager

Under moderate supervision, manage Workers' Compensation Claims with : Stable Lifetime Indemnity and / or Medical Benefits where the medical expenditures are not expected to exceed $6,000 annually and there are settlement opportunities. Death Benefits, payment of award only, minimal active / pending litigation, including mediation.

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.

What Will You Do?

• Manage and resolve stable lifetime claims.
• May 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, (i.e., structured settlement, discontinuation of benefits through litigation). Collaborate with our internal nurse resources (Medical Case Manager) in order to integrate the delivery of medical services into the overall claim strategy.
• 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.
• 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.
• Maintain Continuing Education requirements as required.
• Perform other duties as assigned.

What Will Our Ideal Candidate Have?

What Is a Must Have?

What Is in It for You?

Employment Practices

Travelers is an equal opportunity employer. We value the unique abilities and talents each individual brings to our organization and recognize that we benefit in numerous ways from our differences.

In accordance with local law, candidates seeking employment in Colorado are not required to disclose dates of attendance at or graduation from educational institutions.

If you are a candidate and have specific questions regarding the physical requirements of this role, please send us an email so we may assist you.

Travelers reserves the right to fill this position at a level above or below the level included in this posting.

To learn more about our comprehensive benefit