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Workers Compensation Claim Representative - Experienced

Rancho Cordova, California

Who Are We?

Taking care of our customers, our communities and each other. That's the Travelers Promise. By honoring this commitment, we have maintained our reputation as one of the best property casualty insurers in the industry for over 160 years. Join us to discover a culture that is rooted in innovation and thrives on collaboration. Imagine loving what you do and where you do it.

Compensation Overview

The annual base salary range provided for this position is a nationwide market range and represents a broad range of salaries for this role across the country. The actual salary for this position will be determined by a number of factors, including the scope, complexity and location of the role; the skills, education, training, credentials and experience of the candidate; and other conditions of employment. As part of our comprehensive compensation and benefits program, employees are also eligible for performance-based cash incentive awards.

Salary Range

$59,000.00 - $97,300.00

Target Openings

1

What Is the Opportunity?

Manage Workers' Compensation claims with lost time to conclusion and negotiate settlements where appropriate to resolve claims. Coordinate medical and indemnity position of the claim with a Medical Case Manager. Independently handles assigned claims of low to moderate complexity where Wage loss and the expectation is a return to work to modified or full duty or obtain MMI with no RTW. There are no litigated issues or minor to moderate litigated issues. The claim may involve minor sprains/ minor to moderate surgery. The injured worker is working modified duty and receiving ongoing medical treatment. The injured worker as returned to work, reached Maximum Medical Improvement (MMI) and is receiving PPD benefits. File will close as soon as the PPD is paid out. With close to moderate supervision, may handle claims of greater complexity where Injured worker (IW) remains out of work and unlikely to return to position. Employer is unable to accommodate the restrictions. The claim involves moderate to complex litigation issues IW has returned to work, reached Maximum Medical Improvement (MMI), and has PPD. File litigated to dispute the permanency rating and/or causality. IW has been released to work with permanent restrictions and there has been a change in the current position. IW is receiving Vocational Rehabilitation. Claims that have been reopened for additional medical treatment on more complex files. Injuries may involve one or multiple back, shoulder or knee surgeries, knee replacements, claims involving moderate to complex offsets, permanent restrictions and/or fatalities. Claims on which a settlement should be considered.

Travelers offers a hybrid work location model that is designed to support flexibility.

#hybrid

What Will You Do?

  • 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.
  • Perform other duties as assigned.

What Will Our Ideal Candidate Have?

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

What is a Must Have?

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

What Is in It for You?

  • Health Insurance: Employees and their eligible family members - including spouses, domestic partners, and children - are eligible for coverage from the first day of employment.
  • Retirement: Travelers matches your 401(k) contributions dollar-for-dollar up to your first 5% of eligible pay, subject to an annual maximum. If you have student loan debt, you can enroll in the Paying it Forward Savings Program. When you make a payment toward your student loan, Travelers will make an annual contribution into your 401(k) account. You are also eligible for a Pension Plan that is 100% funded by Travelers.
  • Paid Time Off: Start your career at Travelers with a minimum of 20 days Paid Time Off annually, plus nine paid company Holidays.
  • Wellness Program: The Travelers wellness program is comprised of tools and resources that empower you to achieve your wellness goals. In addition, our Life Balance program provides access to professional counseling services, life coaching and other resources to support your daily life needs. Through Life Balance, you're eligible for five free counseling sessions with a licensed therapist.
  • Volunteer Encouragement: We have a deep commitment to the communities we serve and encourage our employees to get involved. Travelers has a Matching Gift and Volunteer Rewards program that enables you to give back to the charity of your choice.

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. 


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 programs please visit http://careers.travelers.com/life-at-travelers/benefits/.


About Travelers

The Travelers Companies, Inc. (NYSE: TRV) is a leading property casualty insurer selling primarily through independent agents and brokers. The company's diverse business lines offer its global customers a wide range of coverage in the auto, home and business settings. A component of the Dow Jones Industrial Average, Travelers has more than 30,000 employees and generated revenues of approximately $25 billion in 2010.