About this role
Role Overview
- Meet with injured employees face to face following office visits at a provider's medical facility to assist with the claim process and ensure compliance with their medical treatment plan.
- Contact customer, medical provider and injured parties on claims involving medical treatment and/or disability to coordinate appropriate medical care and return to work.
- Develop strategies to facilitate an injured employee's return to work and achieve maximum medical improvement.
- Evaluate and update treatment and return to work plans within established protocols throughout the life of the claim.
- Coordinate with medical providers to ensure the injured employee is actively participating in a viable treatment plan.
- Evaluate medical treatment requests to ensure that they are reasonable and necessary based upon jurisdictional guidelines.
- Engage specialty resources as needed to achieve optimal resolution (Dial-a-doc, physician advisor, peer reviews, MCU).
- Partner with Claim Professional to provide medical information and disability status necessary to create an overall strategy to achieve an optimal outcome.
- Utilize internal Claim Platform Systems to manage all claim activities on a timely basis.
- Utilize Preferred Provider Network per jurisdictional guidelines.
- Partner with Claim Professional to provide input on medical treatment and recovery time to assist in evaluating appropriate claim reserves.
- Submit accurate billing documentation on all activities as outlined in established guidelines.
- Participate in Telephonic and/or onsite File Reviews.
- Respond to inquiries
- oral and written.
- Keep injured worker apprised of claim status.
Requirements
- RN.
- Disability case management experience.
- Prior clinical experience.
- Familiarity with URAC standards.
- Ability to effectively present file resolution to internal and/or external stakeholders.
- Advanced ability to build and maintain productive relationships with our insureds and deliver results with optimal outcomes.
- Intermediate ability to understand alternatives, influence stakeholders and reach a fair agreement through discussion and compromise.
- Basic 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.
- Thorough knowledge of the nature and extent of injuries, periods of disability, and treatment needed.
- Intermediate ability to demonstrate understanding of WC Products and ability to apply available resources and technology to manage treatment plans and assist with claim resolution.
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.
- 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, discounts and resources that empower you to achieve your wellness goals and caregiving needs. In addition, our mental health program provides access to free professional counseling services, health coaching and other resources to support your daily life needs.
- 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.