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Core Competencies
Role fitCore Competencies
Use this summary to align your resume positioning with the role.
Demonstrates expertise in managing Workers' Compensation claims, including negotiation, investigation, and coordination of medical and legal aspects. Proficient in applying regulatory knowledge and maintaining compliance while ensuring timely resolution and documentation of claims.
Highest-signal resume keywords
Workers' Compensation Claim HandlingNegotiation And Settlement TechniquesClaims Investigation And AssessmentKnowledge Of Insurance ContractsLitigation Management
ATS Keywords
Tailor your resumeApplicant Tracking System Keywords
Tip: use these terms in your resume and cover letter to boost ATS matches.
Hard Skills
Claims InvestigationClaims AssessmentNegotiationSettlement TechniquesMedical KnowledgeLiability DeterminationReserve EstablishmentFraud EvaluationMedicare Set Asides ManagementDocumentation
Soft Skills
Proactive Issue ResolutionCollaboration
Certifications & Qualifications
Insurance License
Industry Keywords
Workers' CompensationStatutory BenefitsLegal And Regulatory ComplianceIndemnityCompensabilityMedical Treatment CoordinationContinuing Education
About the role
Key responsibilities & impact- Manage Workers' Compensation claims with lost time through conclusion
- Negotiate claim settlements where appropriate
- Coordinate medical and indemnity aspects of claims with Medical Case Managers
- Handle assigned low- to moderate-complexity claims independently
- Handle more complex claims with close to moderate supervision
- Investigate claims, assess policy coverage, contact insureds, injured workers, medical providers, and other parties, and determine compensability
- Establish and update reserves and document the rationale
- Manage files for quality, timely contact, proper documentation, and proactive issue resolution
- Coordinate medical treatment and return-to-work efforts with internal nurse resources
- Collaborate with medical and legal specialty resources to pursue claim resolution opportunities
- Develop strategies addressing statutory benefits, medical diagnoses, Medicare Set Asides, and other claim issues
- Prepare required letters and state filings within statutory limits
- Evaluate claims for potential fraud and pursue offset opportunities
- Proactively manage inventory and document action plans for timely file closing or reassignment
- Manage litigation and apply Medicare Set Asides and allocations
- Negotiate settlements within designated authority, using structured settlements or annuities where appropriate
- Perform other duties as assigned
Requirements
What you’ll need- High School Diploma or GED
- 1 year Workers Compensation claim handling experience or successful completion of the WC trainee program
- 2 years Workers Compensation claim handling experience preferred as the ideal candidate qualification
- Ability to conduct investigations and take statements
- Knowledge of insurance contracts, policy conditions, coverage, and compensability
- Intermediate negotiation and settlement techniques
- Knowledge of legal, regulatory, state, and federal laws and statutes applicable to insurance
- Intermediate medical knowledge regarding injuries, disability periods, and treatment
- Intermediate understanding of Workers Compensation products and jurisdictional parameters
- Ability to determine liability, assign claim values, and establish and adjust reserves
- Ability to manage litigation, Medicare Set Asides, offsets, apportionment, contribution, and subrogation
- Ability to maintain required continuing education
- Insurance license(s) may be required and generally must be obtained within three months of starting the job, with ongoing continuing education
Benefits
Comp & perks- Health insurance for employees and eligible family members from the first day of employment
- Dollar-for-dollar 401(k) matching up to the first 5% of eligible pay, subject to an annual maximum
- Paying it Forward Savings Program with annual 401(k) contributions for eligible employees making student loan payments
- Pension Plan 100% funded by Travelers
- Minimum of 20 days Paid Time Off annually
- Nine paid company Holidays
- Wellness program with tools, discounts, resources, and caregiving support
- Free professional counseling services, health coaching, and other mental health resources
- Matching Gift and Volunteer Rewards program
- Performance-based cash incentive awards