Workers Compensation Medical Only Claim Rep - Hartford, CT
VetJobs, Hartford, CT, United States
Job Description
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 170 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.
Attention Military Affiliated Job Seekers Our organization works with partner companies to source qualified talent for their open roles. This position is available to Veterans, Transitioning Military, National Guard and Reserve Members, Military Spouses, Wounded Warriors, and their Caregivers. If you have the required skill set, education requirements, and experience, please click the submit button and follow the next steps.
Compensation Overview The annual base salary range for this position is a nationwide market range and represents a broad range of salaries for this role across the country. The actual salary will be determined by factors such as scope, complexity, location, skills, education, training, credentials, and experience. As part of our comprehensive compensation and benefits program, employees are also eligible for performance-based cash incentive awards.
Salary Range: $45,400.00 – $74,900.00
Opportunity Under moderate to direct supervision, this position is responsible for reviewing, evaluating, approving, and processing Medical Only claims with no lost time beyond statutory waiting period, no salary continuation, and a return to full time work within 90 days if the injured worker is on modified duty and/or total medical paid generally not to exceed $5,000. No attorney involvement or ongoing litigation. 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, will be provided as your candidacy is deemed appropriate for further consideration.
Key Responsibilities
Identify red flags or other issues, such as medical treatment in excess of 180 days or $5,000 in medical expenses, or 90 days if the injured worker is on modified duty.
Evaluate the need to transfer from medical only to the Investigative Case Unit or Return to Work Unit as appropriate.
Respond to insured and injured worker and provider inquiries as necessary.
Determine causal relatedness and medical necessity of minor medical conditions/treatment through the use of tools/guidelines (medical guidelines, medical position statements, etc.).
Coordinate Medical Treatment As Appropriate: review, approve, and make accurate and timely payment of appropriate medical bills and expenses in compliance with State regulations.
Channel claims to preferred network as appropriate.
Complete denials limited to medical issues and communicate denials to impacted parties.
Identify the need for and engage nurse resource for utilization review when appropriate.
File appropriate state forms.
Perform other duties as assigned.
Technical Requirements
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. License(s) must be obtained within three months of starting the job and ongoing continuing education credits must be met as mandated.
Maintain Continuing Education Requirements as required.
Qualifications
College degree.
1–2 years related business experience.
Analytical Thinking: identifies current or future problems or opportunities, analyzes and synthesizes information, identifies cause/effect relationships, and explores alternative solutions.
Strong attention to detail.
Judgment/Decision Making: exercises sound judgment and commits to a position.
Communication: clearly and concisely conveys information verbally and in writing with proper structure and grammar.
Negotiation: influences stakeholders and reaches fair agreement through discussion and compromise.
Principles of Investigation: follows logical sequence of inquiry to reconstruct events related to the loss accurately.
Legal Knowledge: general knowledge of state, federal, and regulatory laws and statutes related to Workers' Compensation.
Medical knowledge: understanding nature and extent of injuries, periods of disability, and treatment needed.
Customer Service: builds and maintains productive relationships with insureds and delivers results with optimal outcomes.
Teamwork: works together in interdependent situations, producing results through shared responsibility.
Planning & Organizing: establishes plans and contingencies to meet current or future goals.
Must Have High School Diploma or GED and one year of customer service experience OR Bachelor’s Degree.
Location City: Hartford
State: Connecticut
Job Details
Auto req ID: 467666BR
Job Category: Claims
Job Code: Ins Insurance
Affiliate Sponsor: Travelers Insurance
Minimum Education Required: High School/GED
#J-18808-Ljbffr
Attention Military Affiliated Job Seekers Our organization works with partner companies to source qualified talent for their open roles. This position is available to Veterans, Transitioning Military, National Guard and Reserve Members, Military Spouses, Wounded Warriors, and their Caregivers. If you have the required skill set, education requirements, and experience, please click the submit button and follow the next steps.
Compensation Overview The annual base salary range for this position is a nationwide market range and represents a broad range of salaries for this role across the country. The actual salary will be determined by factors such as scope, complexity, location, skills, education, training, credentials, and experience. As part of our comprehensive compensation and benefits program, employees are also eligible for performance-based cash incentive awards.
Salary Range: $45,400.00 – $74,900.00
Opportunity Under moderate to direct supervision, this position is responsible for reviewing, evaluating, approving, and processing Medical Only claims with no lost time beyond statutory waiting period, no salary continuation, and a return to full time work within 90 days if the injured worker is on modified duty and/or total medical paid generally not to exceed $5,000. No attorney involvement or ongoing litigation. 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, will be provided as your candidacy is deemed appropriate for further consideration.
Key Responsibilities
Identify red flags or other issues, such as medical treatment in excess of 180 days or $5,000 in medical expenses, or 90 days if the injured worker is on modified duty.
Evaluate the need to transfer from medical only to the Investigative Case Unit or Return to Work Unit as appropriate.
Respond to insured and injured worker and provider inquiries as necessary.
Determine causal relatedness and medical necessity of minor medical conditions/treatment through the use of tools/guidelines (medical guidelines, medical position statements, etc.).
Coordinate Medical Treatment As Appropriate: review, approve, and make accurate and timely payment of appropriate medical bills and expenses in compliance with State regulations.
Channel claims to preferred network as appropriate.
Complete denials limited to medical issues and communicate denials to impacted parties.
Identify the need for and engage nurse resource for utilization review when appropriate.
File appropriate state forms.
Perform other duties as assigned.
Technical Requirements
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. License(s) must be obtained within three months of starting the job and ongoing continuing education credits must be met as mandated.
Maintain Continuing Education Requirements as required.
Qualifications
College degree.
1–2 years related business experience.
Analytical Thinking: identifies current or future problems or opportunities, analyzes and synthesizes information, identifies cause/effect relationships, and explores alternative solutions.
Strong attention to detail.
Judgment/Decision Making: exercises sound judgment and commits to a position.
Communication: clearly and concisely conveys information verbally and in writing with proper structure and grammar.
Negotiation: influences stakeholders and reaches fair agreement through discussion and compromise.
Principles of Investigation: follows logical sequence of inquiry to reconstruct events related to the loss accurately.
Legal Knowledge: general knowledge of state, federal, and regulatory laws and statutes related to Workers' Compensation.
Medical knowledge: understanding nature and extent of injuries, periods of disability, and treatment needed.
Customer Service: builds and maintains productive relationships with insureds and delivers results with optimal outcomes.
Teamwork: works together in interdependent situations, producing results through shared responsibility.
Planning & Organizing: establishes plans and contingencies to meet current or future goals.
Must Have High School Diploma or GED and one year of customer service experience OR Bachelor’s Degree.
Location City: Hartford
State: Connecticut
Job Details
Auto req ID: 467666BR
Job Category: Claims
Job Code: Ins Insurance
Affiliate Sponsor: Travelers Insurance
Minimum Education Required: High School/GED
#J-18808-Ljbffr