Workers Compensation - Return To Work Case Manager 1
Posted on: August 15, 2019
Solid reputation, passionate people and endless opportunities.
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.
- You will manage Workers' Compensation claims with lost time to
conclusion and negotiate settlements where appropriate to resolve
- Coordinate medical and indemnity position of the claim with a
Medical Case Manager.
- Independently handles assigned claims of low to moderate
complexity where Wage loss and the expectation is a return to work
to modified or full duty or obtain MMI with no RTW. There are no
litigated issues or minor to moderate litigated issues.
- The claim may involve minor sprains/ minor to moderate
- The injured worker is working modified duty and receiving
ongoing medical treatment.
- The injured worker as returned to work, reached Maximum Medical
Improvement (MMI) and is receiving PPD benefits.
- File will close as soon as the PPD is paid out.
- With close to moderate supervision, may handle claims of
greater complexity where Injured worker (IW) remains out of work
and unlikely to return to position.
- Employer is unable to accommodate the restrictions.
- The claim involves moderate to complex litigation issues IW has
returned to work, reached Maximum Medical Improvement (MMI), and
- File litigated to dispute the permanency rating and/or
causality. IW has been released to work with permanent restrictions
and job is no longer available.
- IW is receiving Vocational Rehabilitation.
- Claims that have been reopened for additional medical treatment
on more complex files. Injuries may involve one or multiple back,
shoulder or knee surgeries, knee replacements, claims involving
moderate to complex offsets, permanent restrictions and/or
- Claims on which a settlement should be considered.
- 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.
- This job does not manage others. This job works under Moderate
Supervision: Incumbent performs standard and routine assignments
independently to conclusion; unusual problems which may require
exceptions to procedures or processes are referred to the
Opportunity to work in a customer service driven atmosphere! After
1 year in the role, there is an opportunity for work at home 2-3
days per week. Great team environment!
Primary Job Duties & Responsibilities
- Conduct investigations, including, but not limited to assessing
policy coverage, contacting insureds, injured workers, medical
providers, and other parties in a timely manner to determine
- Establish and update reserves to reflect claim exposure and
- Identify and set actuarial reserves.
- Apply knowledge to determine causal relatedness of medical
- Manage files with an emphasis on file quality (including timely
contact and proper documentation and proactive resolution of
- Achieve a positive end result by returning injured party to
work and coordinating the appropriate medical treatment.in
collaboration with internal nurse resources where appropriate.
- Work in collaboration with specialty resources (i.e. medical
and legal) to proactively pursue claim resolution opportunities,
(i.e. return to work, structured settlement, and discontinuation of
benefits through litigation).
- Develop strategies to manage losses involving issues of
statutory benefit entitlement, medical diagnoses, Medicare and set
aside to achieve resolution through the best possible outcome.
- Collaborate with our internal nurse resources (Medical Case
Manager) in order to integrate the delivery of medical services
into the overall claim strategy.
- Prepare necessary letters and state filings within statutory
limits. Pursue all offset opportunities, including apportionment,
contribution and subrogation.
- Evaluate claims for potential fraud.Proactively manage
inventory with documented plans of action to ensure timely and
appropriate file closing or reassignment.
- Effectively manage litigation to drive files to an optimal
outcome, including resolution of benefits. Understand and apply
Medicare Set Asides and allocations.
- Negotiate settlement of claims within designated
- May use structured settlement/annuity as appropriate for the
- 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. Customer Engagement Participate in Telephonic and/or
onsite File Review.
- Respond to inquiries - verbal and written.
- Keep injured worker apprised of claim status.
- Engage specialty resources as needed.
- Perform other duties as assigned.
High School Diploma or GED required. Minimum of 1 year Workers
Compensation claim handling experience or successful completion of
the WC trainee program required.
Education, Work Experience & Knowledge
- College degree preferred.
- 2 years Workers Compensation claim handling experience
Job Specific & Technical Skills & Competencies
- 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
- Communication: Expresses, summarizes and records thoughts
clearly and concisely orally and in writing by applying proper
content, format, sentence structure, grammar, language and
- 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.
- General 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
- Principles of Investigation: Intermediate 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: Intermediate knowledge of the nature and
extent of injuries, periods of disability, and treatment
- 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. Intermediate
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.
- Customer Service: Advanced ability to build and maintain
productive relationships with our insureds and deliver results with
- Teamwork: Advanced ability to work together in situations when
actions are interdependent and a team is mutually responsible to
produce a result Planning & Organizing: Advanced ability to
establish a plan/course of action and contingencies for self or
others to meet current or future goals
bi-lingual candidates encouraged to apply
Operates standard office equipment - Frequently Sitting (Can stand
at will) - Frequently Use of Keyboards, Sporadic 10-Key-
Licensing or Certificates
Maintain Continuing Education requirements as required or as
mandated by state regulations
Equal Employment Opportunity Statement
Travelers is an equal opportunity employer.
Keywords: Travelers, Alpharetta , Workers Compensation - Return To Work Case Manager 1, Executive , Alpharetta, Georgia
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