Claims Medical Only Representative - Melville, United States - The Travelers Companies, Inc.

Description

Taking care of our customers, our communities and each other.

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.

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 skills, education, training, credentials and experience of the candidate; As part of our comprehensive compensation and benefits program, employees are also eligible for performance-based cash incentive awards.

Target Openings

This position handles First Party Medical Litigation or Arbitration claims from the first notice of suit/arbitration to resolution/settlement and payment process.

Provides quality claim handling throughout the litigation/arbitration life cycle (attorney/provider contacts, coverage, investigation, evaluation, reserving, negotiation and resolution) including maintaining full compliance with internal and external quality standards and state specific regulations.

Review and analyze coverage and policy conditions, provisions, exclusions and endorsements, and how jurisdictional issues impact the claim. Confirm proper application of any deductibles, coverage limits, etc. Prompt review of claim file and handling procedures to determine validity of the action.

Review of current legal/jurisdictional resources and applicable case law in conjunction with Claim counsel and First Party Medical claim professional, if necessary.

Proactively manage ongoing litigation/arbitration through prompt, consistent follow up with Claim counsel and other applicable resources.
Establish timely and maintain appropriate claim and expense reserves to reflect the overall claim exposure.

Manage file inventory and expense reserves by utilizing an effective diary system, documenting claim file activities to resolve claim in a timely manner.

Determine settlement amounts, negotiate and convey claim settlements within authority limits to attorneys, providers and claimants.

Develop resolution plan with staff or panel counsel, and track and control legal expenses; Attend depositions, mediations, arbitrations, pre-trials, trials and all other legal proceedings, as needed.

Nurse, SIU, claim counsel, property, etc.) Recognize cases based on severity protocols to be referred timely to next level claim professional.

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.

Associate's or Bachelor's degree or equivalent business experience preferred.
Prior First Party Medical and/or litigation claim handling experience preferred.
Strong keyboard skills and Windows proficiency, including Excel and Word.
Insurance Contract Knowledge - Intermediate
Legal Knowledge - Intermediate
Medical Knowledge - Intermediate
A minimum of one year prior First Party Medical or litigation claim handling experience required.

Employees and their eligible family members – including spouses, domestic partners, and children – are eligible for coverage from the first day of employment.

Retirement:

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.

Volunteer Encouragement:
We have a deep commitment to the communities we serve and encourage our employees to get involved.

We believe that we can deliver the very best products and services when our workforce reflects the diverse customers and communities we serve.

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