Auto First Party Medical Litigation Specialist
Who Are We?
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.
The annual base salary range provided for this position is a nationwide market range and represents a broad range of salaries for this role across the country. The actual salary for this position will be determined by a number of factors, including the scope, complexity and location of the role; the skills, education, training, credentials and experience of the candidate; and other conditions of employment. As part of our comprehensive compensation and benefits program, employees are also eligible for performance-based cash incentive awards.
Salary Range$55,400.00 - $91,300.00
What Is the Opportunity?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.
What Will You Do?
- 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.
- 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.
- 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.
- 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.
- Perform other duties as assigned.
What Will Our Ideal Candidate Have?
- Associate or Bachelor degree or equivalent business experience preferred.
- 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
What is a Must Have?
- High School Degree or GED required.
- A minimum of one year prior First Party Medical or litigation claim handling experience required.
What Is in It for You?
- 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. If you have student loan debt, you can enroll in the Paying it Forward Savings Program. When you make a payment toward your student loan, Travelers will make an annual contribution into your 401(k) account. You are also eligible for a Pension Plan that is 100% funded by Travelers.
- 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 and resources that empower you to achieve your wellness goals. In addition, our Life Balance program provides access to professional counseling services, life coaching and other resources to support your daily life needs. Through Life Balance, you're eligible for five free counseling sessions with a licensed therapist.
- Volunteer Encouragement: We have a deep commitment to the communities we serve and encourage our employees to get involved. Travelers has a Matching Gift and Volunteer Rewards program that enables you to give back to the charity of your choice.
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/.