Workers Compensation Benefit Management Case Manager

Website Travelers Insurance

Experience handling workers compensation claims in Oregon and/or Washington is strongly preferred.

Manage and resolve those claims where pre-injury return to work is unlikely.
May use structured settlement/annuity as appropriate for the jurisdiction.
Develop strategies to manage losses involving complex issues of statutory benefit entitlement, medical diagnoses, Medicare Set Aside to achieve resolution through the best possible outcome.
Manage litigation to drive files to an optimal outcome, including discontinuation of benefits.
Manage existing offsets, including apportionment, contribution and subrogation.
Facilitate timely claim resolution by leveraging any mitigation opportunities.
Establish and update reserves to reflect claim exposure and document rationale. Includes setting lifetime reserves with the assistance and oversight of MCU.
Work in collaboration with specialty resources (i.e. medical and legal) to proactively pursue claim resolution opportunities, (i.e., structured settlement, discontinuation of benefits through litigation). Collaborate with our internal nurse resources (Medical Case Manager) in order to integrate the delivery of medical services into the overall claim strategy.
Apply knowledge to determine causal relatedness of medical conditions.
Negotiate settlement of claims within designated authority.
Proactively manage inventory with documented plans of action to ensure timely and appropriate file closure or reassignment.
Manage cases telephonically with an emphasis on maximizing quality and controlling costs through aggressive case resolution.
Review, approve and issue accurate and timely indemnity, medical and expense payments for lifetime/long-term claims.
Determine Value of Claim.
Complete required letters and state forms and any other required documents as required.
Establish and maintain incurreds which reflect the exposure of the claim, and document a clear reserve rationale.
Apply coverage (limits, endorsements).
Determine and apply offset/contribution from 3rd party, second injury fund, liens, etc.
Develop and Execute Resolution Strategy.
Determine and actively develop ongoing strategic plans for resolution as required and when a significant event impacts the claim.
Utilize and manage resources as necessary to resolve outstanding issues.
Communicate and complete denials on medical and indemnity issues.
Manage inventory to ensure timely file closing or timely reassignment if necessary.
Settlement Evaluation and Negotiation.
Evaluate and document a detailed settlement analysis, value and range within settlement authority.
Execute negotiation strategy and communicate status.
Identify and evaluate the need for Allocation or Medicare Set Aside and make appropriate referral.
Customer Engagement.
Participate in Telephonic and/or onsite File Reviews.
Respond to inquiries – verbal and written.
Keeping injured worker apprised of claim status.
Engage specialty resources as needed.
May act as technical resource to others.
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.
Maintain Continuing Education requirements as required.
Other duties as assigned.
Perform other duties as assigned.

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