Major Case Specialist, Workers Compensation (Based in CA, AZ, or CO)
Location: Greenwood Village Colorado
Description: Travelers is at present recruited Major Case Specialist, Workers Compensation (Based in CA, AZ, or CO) right now, this position will be placed in Colorado. Detailed specification about this position opportunity kindly read the description below. 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.
SUMMARY: Position to be located in either California, Arizona or Colorado and will be based in one of the Travelers Claim Centers. Provide expert claim handling in areas of coverage, compensability, investigation, evaluation, negotiation, litigation management and resolution of serious and complex claims in accordance with Best Practices. Provide quality claim handling expertise and superior customer service on assigned claims, while engaging in indemnity & expense management. Provide consulting and training and serves as an expert technical resource to other claim professionals, business partners, customers, and other stakeholders as appropriate or required.
PRIMARY DUTIES: Co-manage the company's most serious or complex Workers' Compensation claims. Provide efficient, prompt, courteous service and communication to internal business partners and external customers about resolution of coverage, compensability, reserves and other claim service issues. Recommend and document appropriate and timely case reserves. Reinforce Company claim policies, procedures, practices and standards for handling claims to Claim Service Centers.
Assist in developing and managing litigation strategies and participate, as appropriate, in mediation conferences. Properly assess the risks associated with all appeals in order to manage decisions that have either significant financial exposure or the potential of making bad case law. Develop and recommend creative resolution strategies. Prepare timely and informative management reports (Claim File Analysis) and presentation materials.
Represent the company as a technical resource, attend legal proceedings as needed, act within established professional guidelines as well as applicable state laws Direct the complete and thorough investigation of all facts relevant to claim files meeting large loss criteria. Evaluate claims by thoroughly analyzing coverage, compensability, causation, offsets and exposure. Provide settlement rationale and settlement value analysis to customers, brokers and other interested departments. Provide direction and authority in the settlement process where the exposure exceeds field office authority.
Actively engage in the identification, selection and direction of appropriate internal and/or external resources for specific activities required to effectively evaluate claims, such as Actuarial, Reinsurance, Customer Service, Structure Settlements, Subrogation, Risk Control, nurse consultants, and fraud investigators, and other experts. Provide oversight on files in litigation and provide assistance in the negotiation strategy. Prepare files for senior management on cases where settlement authority is requested in excess of $1 million. Update appropriate parties as needed, providing new facts as they become available, and their impact upon the liability analysis and settlement options.
Recognize cases, based on severity/complexity protocols, that should be transferred to another level of claim professional and refer on a timely basis. Appropriately deal with information that is considered personal and confidential. Fulfill specific service commitments made to certain accounts, as outlined in Special Account Communication (SAC) instructions, and inquires from agents and brokers. Actively provide mentoring and coaching to less experienced claim professionals to increase the technical expertise and improve bench strength.
Share accountability with business partners to achieve and sustain quality results. Evaluate all claims for recovery potential; directly handle recovery efforts and/or engage and direct Company resources for recovery efforts. May be responsible to research and evaluate current information regarding trends in the law; digest and communicate this information to other Company departments and divisions to assist in underwriting and management decisions. May assist underwriting business partners in marketing and account-contact efforts.
May participate in periodic file quality reviews. EDUCATION/COURSE OF STUDY: College degree or equivalent business experience. WORK EXPERIENCE: State insurance adjusting license (where applicable) and ongoing satisfaction of any necessary continuing education requirements. 7+ years claim handling experience with 5 years experience handling serious injury claims preferred Extensive working level knowledge and skill in various business line products Excellent negotiation and customer service skills Advanced skills in coverage, liability and damages analysis with expert understanding of the litigation process in both state and federal courts, including relevant case and statutory law and procedure; expert litigation management skills.
Extensive claim and/or legal experience and thus the technical expertise to evaluate severe and complex claims. Able to make independent decisions on most assigned cases without involvement of supervisor. Openness to the ideas and expertise of other individuals and actively solicits input and shares ideas. Thorough understanding of commercial lines products, policy language, exclusions, ISO forms, and effective claims handling practices.
Demonstrated strong coaching, influence and persuasion skills. An expert/mastery knowledge/skill level in claims. An advanced knowledge/skill level in actuarial, litigation, marketing and medical. A basic working knowledge/skill level in CL products, mathematics/ statistics and training and development.
Demonstrate knowledge of the various jurisdictional rules for Workers' Compensation medical payments. 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 Can adapt to and support cultural change Strong technology aptitude; ability to use business technology tools to effectively research, track, and communicate information. Demonstrated history of strong mentoring relationships and influence management skills throughout an organization. OTHER: Thorough understanding of product lines, objectives of claim management and legal theory issues involving claim resolution Utilize technology as a strategic tool Thorough understanding of coverage, compensability, causation and benefits administration of claims Ability to recognize, analyze and assist in resolution of complex claim, medical and settlement issues Ability to assess and manage expenses and claim resolution through inventory analysis and management Superior business relationships with business and marketing partners Ability to travel 16 to 30 nights per year.
Incumbents who fill this position will be subject to periodic post-hire criminal background checks while employed in this position. As a condition of acceptance for the position, selected candidates for this position will be required to electronically accept the Fair Credit Reporting Act (FCRA) Disclosure Statement and Authorization included in the online employment application. You may also be subsequently asked to accept similar FCRA authorizations periodically throughout your employment with the Company. Travelers is an equal opportunity employer.
We actively promote a drug-free workplace.
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If you were eligible to this position, please email us your resume, with salary requirements and a resume to Travelers.
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This position starts available on: Fri, 13 Jul 2012 12:36:16 GMT
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