Claim Rep Auto 1st Party MedI

Middleboro, Massachusetts

Company Information
Solid reputation, passionate people and endless opportunities. That's Travelers. Our superior financial strength and consistent record of strong operating returns mean security for our customers - and opportunities for our employees. You will find Travelers to be full of energy and a workplace in which you truly can make a difference.

Job Summary
Under moderate supervision, this position handles First Party Medical claims from the first notice of loss through resolution/settlement and payment process. Provide 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. This job does not lead others. 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.

Primary Job Duties & Responsibilities
Customer Contacts/Experience: Deliver consistent service quality throughout the claim life cycle, including but not limited to prompt contact, explaining the process, setting expectations, on-going communication, follow-through and meeting commitments to achieve optimal outcome on every file. Fulfill specific service commitments made to certain accounts, as outlined in Special Account Communication (SAC). Coverage Analysis: Review and analyze coverage and apply policy conditions, provisions, exclusions and endorsements, and how jurisdictional issues impact the claim. Verify the benefits available, the injured party's eligibility and the applicable limits. Address proper application of any deductibles, co-insurance, coverage limits, etc. Confirm priority of coverage i.e.: primary, secondary, concurrent or not applicable, and take into consideration other issues such as Social Security, Workers Compensation or others relevant to the jurisdiction. Investigation/Evaluation: Investigate each claim to obtain relevant facts necessary to determine coverage, causation/damages, medical necessity, treatment plan, damages, and exposure with respect to the various coverages provided through prompt contact with appropriate parties (e.g. policyholders, accounts, claimants, law enforcement agencies, witnesses, agents, medical providers and technical experts). This may also include investigation of wage loss and essential services claims including verification of coverage, employment, loss of income due to accident and medical disability to support wage loss or need for essential services to ensure validity of the claim. Take necessary statements. Proactively manage medical treatment based on the nature and extent of injury, mechanism of injury, type of treatment received or anticipated, and wage loss through case management and use of medical resources as needed. Proactively manage the process to ensure proper payment, (i.e.: review medical bills and medical records for appropriateness of billing/fees and the services rendered ensuring that all records have a determination of medical necessity and causal relationship to the loss.). Reserving: 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. Negotiation/Resolution: Determine settlement amounts, negotiate and convey claim settlements within authority limits to insureds and claimants. As appropriate, write denial letters, Reservation of Rights and other necessary correspondence to insureds and claimants. May handle litigated files on appropriately assigned cases. Develop resolution plan with staff or panel counsel, and track and control legal expenses; Review conciliations and prepare submissions for arbitration and/or mediation hearings. May also attend arbitrations as Company witness. Attend d. 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.

Minimum Qualifications
High School Degree or GED with a minimum of one year auto claim handling experience or successful completion of Travelers Claim Representative training program required.

Education, Work Experience & Knowledge
Associates Degree or Bachelors degree with 2 years auto claim handling experience preferred. Prior Auto 1st Party Medical experience preferred. Knowledge of medical terminology preferred.

Job Specific & Technical Skills & Competencies
Strong keyboard skills and Windows proficiency, including Excel and Word. Demonstrated ownership attitude and customer centric response to all assigned tasks. Strong verbal and written communication skills. Attention to detail ensuring accuracy. Ability to work in a high volume, fast paced environment managing multiple priorities. Competency Levels: Analytical Thinking: Intermediate. Judgment/Decision Making: Intermediate. Communication: Intermediate. Negotiation: Intermediate. Insurance Contract Knowledge: Intermediate. Principles of Investigation: Intermediate. Value Determination: Intermediate. Settlement Techniques: Intermediate. Legal Knowledge: Basic. Medical Knowledge: Intermediate.

Physical Requirements
Operates standard office equipment: Frequently). Sitting (Can stand at will): Continuously. Use of Keyboards, Sporadic 10-Key: Continuously.

Equal Employment Opportunity Statement
Travelers is an equal opportunity employer.
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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.