Auto First Party Medical Claim Representative

$59,200 - $97,700/Yr

The Travelers Companies - Franklin, TN

Full-time - Entry Level

Hybrid - Franklin, TN

Insurance Carriers and Related Activities

About the position

This position is responsible for handling Personal and Business Insurance First Party Medical claims from the first notice of loss through resolution/settlement and payment process. This may include applying laws and statutes for multiple state jurisdictions. Provides 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.

Responsibilities

• Delivers 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.
• Reviews and analyzes coverage and applies policy conditions, provisions, exclusions and endorsements for assigned jurisdictions.
• Investigates each claim to obtain relevant facts necessary to determine coverage, causation/damages, medical necessity, treatment plan, damages, and exposure.
• Proactively manages medical treatment based on the nature and extent of injury, mechanism of injury, type of treatment received or anticipated, and wage loss.
• Establishes timely and maintains appropriate claim and expense reserves to reflect the overall claim exposure.
• Determines settlement amounts, negotiates and conveys claim settlements within authority limits to insureds and claimants.
• May handle litigated files on appropriately assigned cases.
• Acquisition and maintenance of Insurance License(s) may be required to comply with state and Travelers requirements.
• Perform other duties as assigned.

Requirements

• 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.
• Associate's Degree or Bachelor's degree with 2 years auto claim handling experience preferred.
• Prior Auto First Party Medical experience preferred.
• Knowledge of medical terminology preferred.
• Demonstrated ownership attitude and customer centric response to all assigned tasks.
• Attention to detail ensuring accuracy.
• Ability to work in a high volume, fast paced environment managing multiple priorities.
• Keyboard skills and Windows proficiency, including Excel and Word - Intermediate.
• Verbal and written communication skills - Intermediate.
• Analytical Thinking: Intermediate.
• Judgment/Decision Making: Intermediate.
• Negotiation: Intermediate.
• Insurance Contract Knowledge: Intermediate.
• Principles of Investigation: Intermediate.
• Value Determination: Intermediate.
• Settlement Techniques: Intermediate.
• Legal Knowledge: Basic.
• Medical Knowledge: Intermediate.

Benefits

• Health Insurance: Employees and their eligible family members - including spouses, domestic partners, and children - are eligible for coverage from the first day of employment.
• Retirement: Travelers matches your 401(k) contributions dollar-for-dollar up to your first 5% of eligible pay, subject to an annual maximum.
• Paid Time Off: Start your career at Travelers with a minimum of 20 days Paid Time Off annually, plus nine paid company Holidays.
• Wellness Program: The Travelers wellness program is comprised of tools, discounts and resources that empower you to achieve your wellness goals and caregiving needs.
• Volunteer Encouragement: We have a deep commitment to the communities we serve and encourage our employees to get involved.