Workers Compensation Benefit Management Case Manager
Company: The Travelers Companies, Inc.
Location: Lake Oswego
Posted on: May 1, 2024
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Job Description:
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 OverviewThe 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$60,600.00 - $100,100.00Target Openings1What Is the
Opportunity?Under moderate supervision, manage Workers'
Compensation claims with: Active Lifetime Indemnity and/or Medical
Benefits where the medical expenditures exceed $6,000 annually and
there are settlement opportunities. Claims with lifetime medical
and the indemnity is capped. Litigation for ongoing
benefits/entitlement does not include temporary indemnity
benefits.Experience handling workers compensation claims in Oregon
and/or Washington is strongly preferred.What Will You Do?Manage and
resolve those claims where pre-injury return to work is
unlikely.May use structured settlement/annuity as appropriate for
the jurisdiction.Develop strategies to manage losses involving
complex issues of statutory benefit entitlement, medical diagnoses,
Medicare Set Aside to achieve resolution through the best possible
outcome.Manage litigation to drive files to an optimal outcome,
including discontinuation of benefits.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. Includes setting lifetime reserves
with the assistance and oversight of MCU.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 required 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.May act as technical resource to
others.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.Other duties as assigned.Perform other duties as
assigned.What Will Our Ideal Candidate Have?College degree
preferred.2+ years Workers Compensation claim handling experience
preferred.Experience handling workers compensation claims in Oregon
and/or Washington is strongly preferred.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.Working 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: Basic 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.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. Knowing available medical
resources and when to utilize these resources.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 outcomesTeamwork:Advanced ability to work together in
situations when actions are interdependent and a team is mutually
responsible to produce a resultPlanning & Organizing:Advanced
ability to establish a plan/course of action and contingencies for
self or others to meet current or future goalsWhat 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.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, discounts and resources that empower you to
achieve your wellness goals and caregiving needs. In addition, our
mental health program provides access to free professional
counseling services, health coaching and other resources to support
your daily life needs.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 PracticesTravelers is an equal opportunity
employer. We believe that we can deliver the very best products and
services when our workforce reflects the diverse customers and
communities we serve. We are committed to recruiting, retaining and
developing the diverse talent of all of our employees and fostering
an inclusive workplace, where we celebrate differences, promote
belonging, and work together to deliver extraordinary results.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 programs please visit
http://careers.travelers.com/life-at-travelers/benefits/.0
Keywords: The Travelers Companies, Inc., Vancouver , Workers Compensation Benefit Management Case Manager, Human Resources , Lake Oswego, Washington
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