Auto First Party Medical Claim Representative Trainee
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Job Description SummaryThis is an entry level position that requires satisfactory completion of a formal training program to advance to Claim Representative - Auto First Party Medical position. This position is intended to develop skills for investigating, evaluating, negotiating and resolving First Party Medical claims on losses of lesser value and complexity. 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. 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.
Primary Job Duties & Responsibilities
- Completes required training program which includes the overall instruction, exposure, and preparation for employees to progress to the next level position. It is a mix of online, virtual, classroom, and on-the-job training. The training may require travel.
- The on the job training includes practice and execution of the following core assignments:
- Participates in on-going training sessions for the inside auto business.
- Works closely with Unit Manager or mentor to promptly resolve assigned claim.
- Customer Contacts/Experience:
- 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.
- Coverage Analysis:
- Reviews and analyzes coverage and applies policy conditions, provisions, exclusions and endorsements for assigned jurisdictions. Verifies the benefits available, the injured party's eligibility and the applicable limits. Addresses proper application of any deductibles, co-insurance, coverage limits, etc. Confirms priority of coverage (i.e. primary, secondary, concurrent) and takes into consideration other issues such as Social Security, Workers Compensation or others relevant to the jurisdiction.
- Investigates each claim to obtain relevant facts necessary to determine coverage, causation/damages, medical necessity, treatment plan, damages, and exposure with respect to the various coverages provided through prompt contact with appropriate parties (e.g. policyholders, medical providers and technical experts). This may also include investigation of wage loss and essential services claims. Takes recorded statements as necessary.
- Establishes timely and maintains appropriate claim and expense reserves to reflect the overall claim exposure. Manages file inventory and expense reserves by utilizing an effective diary system, documenting claim file activities to resolve claim in a timely manner.
- Determines settlement amounts, negotiates and conveys claim settlements within authority limits to insureds and claimants. As appropriate, writes denial letters, Reservation of Rights and other necessary correspondence to insureds and claimants.
- Proactively manages medical treatment based on the nature and extent of injury, mechanism of injury, type of treatment received or anticipated, and wage loss through case management and use of medical resources as needed. Proactively manages the process to ensure proper payment, (i.e. review medical bills and medical records for appropriateness of billing/fees and the services rendered ensuring that all records have a determination of medical necessity and causal relationship to the loss).
- Insurance License:
- 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.
- High School Diploma or GED and one year of customer service experience OR Bachelor's Degree required.
Education, Work Experience, & Knowledge
- Bachelor's Degree preferred or a minimum of 2 years of work OR customer service related experience preferred.
Job Specific Technical Skills & Competencies
- Demonstrated ownership attitude and customer centric response to all assigned tasks
- Demonstrated good organizational skills with the ability to prioritize and work independently
- Attention to detail ensuring accuracy
- Keyboard skills and Windows proficiency, including Excel and Word - Intermediate
- Verbal and written communication skills - Intermediate
- Analytical Thinking-Basic
- Judgment/Decision Making- Basic
Environmental / Work Schedules / Other
- Travel Requirements: Travel Occasionally
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/.