Who Are We?
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 160 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.
Job Category
Claim
Compensation Overview
The annual base salary range provided for this position is a nationwide market range and represents a broad range of salaries for this role across the country. The actual salary for this position will be determined by a number of factors, including the scope, complexity and location of the role; the skills, education, training, credentials and experience of the candidate; and other conditions of employment. As part of our comprehensive compensation and benefits program, employees are also eligible for performance-based cash incentive awards.
Salary Range
$57,500.00 - $94,900.00
Target Openings
1
What Is the Opportunity?
This position handles First Party Medical investigations that lead to resolution of claims. Provides quality claim handling throughout the investigation in partnership with internal and external business partners, creating an investigation strategy inclusive of evaluation, reserving, negotiation and resolution) including maintaining full compliance with internal and external quality standards and state specific regulations. What Will You Do?

• Investigation/Evaluation:
• Create and manage ongoing medical investigation strategy. Obtain relevant facts necessary to continually evaluate medical billing and treatment patterns to identify and deter fraudulent billing. This may also include investigations through internal and external resources and analytics Investigative strategy may include Examinations Under Oath, medical site visits, surveillance, provider link analysis, etc. Effectively partner with Travelers Investigative Unit, Claim Legal and outside investigative agencies as necessary.
• Partnership:
• Actively engage in the identification, selection and direction of appropriate resources for specific activities required to effectively evaluate medical bills and providers. Effectively partner with resources to establish strategies specific to each investigation. Actively participate in scheduled meetings with partner resources to drive sustainable defenses.
• Quality Standards:
• Consistently meet all state regulatory requirements and organizational goals including but not limited to consistent proactive communications with all partners, adherence to set timelines for follow-through, precise handling of all medical bills and documentation of claim file activities.
• Reserving:
• Establish timely and appropriate claim expense reserves while making accurate indemnity reserve recommendations to internal partners. Manage provider bills and expense reserves by effectively utilizing all claim tools (dashboard, diary system, medical software, etc.).
• Negotiation/Resolution:
• Review and analyze documents to determine appropriate resolution strategies. Leverage all internal and external investigative records to drive strategies.
• Request additional information, as appropriate, either through written or verbal communication with providers directly or through partnerships.
• Issue denial/delay letters, as required; request examinations under oath or any other necessary correspondence to providers, insureds or claimants as needed to resolve the matter efficiently. Work in collaboration with the First Party Medical file handler to ensure proper medical management procedures are followed.
• 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.
• Perform other duties as assigned.

What Will Our Ideal Candidate Have?

• Associate or Bachelor degree or equivalent business experience preferred.
• Prior First Party Medical claim handling experience preferred.
• Strong keyboard skills and Windows proficiency, including Excel and Word.
• Demonstrated ownership attitude and customer centric response to all assigned tasks.
• Strong verbal and written communication skills.
• Attention to detail ensuring accuracy.
• Ability to work in a high volume, fast paced environment managing multiple priorities
• Competency Levels:
• Analytical Thinking - Intermediate
• Judgment/Decision Making - Intermediate
• Communication - Intermediate
• Negotiation - Intermediate
• Insurance Contract Knowledge - Intermediate
• Principles of Investigation - Intermediate
• Value Determination - Intermediate
• Settlement Techniques - Intermediate
• Legal Knowledge - Intermediate
• Medical Knowledge - Intermediate

What is a Must Have?

• High School Degree or GED required.

What Is in It for You?

• 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.

Employment Practices
Travelers is an equal opportunity employer. We believe that we can deliver the very best products and services when our workforce reflects the diverse customers and communities we serve. We are committed to recruiting, retaining and developing the diverse talent of all of our employees and fostering an inclusive workplace, where we celebrate differences, promote belonging, and work together to deliver extraordinary results.
In accordance with local law, candidates seeking employment in Colorado are not required to disclose dates of attendance at or graduation from educational institutions.
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/.