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Auto Personal Injury Protection Claim Representative

Naperville, Illinois

Company Summary

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.

Target Openings

1

Job Description Summary

This position handles First Party Medical Litigation claims from the first notice of suit to resolution/settlement and payment process. Provides quality claim handling throughout the litigation 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. Financial impact complexity exposure is based on jurisdiction and statutory limits; complexity exposure may vary based on jurisdictional application of how attorney fees are awarded. Provides consulting and training resources, and serves as a contact and technical resource to the First Party Medical Unit and our business partners to assist in building a case to defend from claim inception. This position primarily handles litigation claims but may also handle arbitration claims if necessary. 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.

Travelers offers a hybrid work location model that is designed to support flexibility. Employees in this position are part of a training or development program that may require up to a six-month waiting period before they are eligible for the hybrid model. During the initial six-month training program, employees may be required to work up to five days in the office.

Primary Job Duties & Responsibilities

  • Coverage Analysis:
  • Review and analyze coverage and policy conditions, provisions, exclusions and endorsements, and how jurisdictional issues impact the claim. Confirm the benefits available, the injured party's eligibility and the applicable limits. Confirm proper application of any deductibles, 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:
  • Evaluate each suit to obtain relevant facts necessary to determine defensibility and potential exposure. Evaluate corporate exposure based on statute, case law and multiple policy forms to determine financial exposure including extra contractual (attorney fees, fines & penalties.) 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 through prompt, consistent follow up with Claim counsel and other applicable resources.
  • 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 attorneys, providers and claimants. As appropriate, write denial letters, Reservation of Rights and other necessary correspondence to attorneys, providers and claimants.
  • Develop resolution plan with staff or panel counsel, and track and control legal expenses; Review conciliations and prepare submissions for mediation hearings. May also attend arbitrations as Company witness if necessary.
  • Attend depositions, mediations, pre-trials, trials and all other legal proceedings, as needed.
  • Recognize and engage the appropriate resources (i.e. Nurse, SIU, claim counsel, property, etc.) to move the file towards appropriate resolution. Identify subrogation opportunities, determine appropriateness of the demand and negotiate adverse subrogation.
  • Provides consulting and training resources, and serves as a contact and technical resource to the First Party Medical Unit and our business partners to assist in building a case to defend from claim inception.
  • 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. Generally, license(s) must be obtained within three months of starting the job and obtain ongoing continuing education credits as mandated.

Minimum Qualifications

  • High School Degree or GED required.
  • A minimum of one year prior First Party Medical or litigation claim handling experience required.

Education, Work Experience, & Knowledge

  • Associate or Bachelor degree or equivalent business experience preferred.

Job Specific Technical Skills & Competencies

  • Strong negotiation and customer service skills.
  • Skilled in coverage, liability and damages analysis and has a thorough understanding of the litigation process, relevant case and statutory law and expert litigation management skills.
  • Extensive claim and/or legal experience and technical expertise to evaluate high exposure litigated claims.
  • Able to make independent decisions on most assigned cases without involvement of supervisor.
  • Thorough understanding of First Party Medical and effective claims handling practices
  • Demonstrated coaching, influence and persuasion skills.
  • Advanced written and verbal communication skills are required so as to understand, synthesize, interpret and convey, in a simplified manner, complex data and information to audiences with varying levels of expertise.
  • Strong technology aptitude; ability to use business technology tools to effectively research, track, and communicate information.
  • 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 Intermediate
  • Medical Knowledge Intermediate

Environmental / Work Schedules / Other

  • Travel Requirements: Travel Occasionally

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.