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Job Description
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Workers Comp-Benefit Management Claim Analyst
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792742
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03/26/2010
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CA-Walnut Creek
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Committed. Competitive. Constructing our Future.
That's Travelers. We are one of the leading insurance companies in the United States. Our superior financial strength and consistent record of strong operating returns mean security for our customers - and opportunities for our employees. You will find Travelers to be full of energy, and a workplace in which you truly can make a difference.
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Location: Walnut Creek, CA
SUMMARY:
Ensure that all benefits to which the injured worker or his dependent(s) is(are) entitled to are paid accurately and timely.
Ensure that all claims are evaluated and reserved adequately.
Promptly identify deterioration in the injured worker¿s medical condition and make timely referral for medical intervention or re-assignment.
Review and complete the Annual Medical Actuarial Update form, including projecting future annual medical costs.
Review the claim at appropriate intervals to ensure all Benefit Management claims are reserved adequately and complete an action/resolution plan.
Maintain files for all issues, including: causal relationship, change of condition, request for medical treatment such as surgery and pain management, settlement potential, prescription management, Medicare Set-Asides, etc.
Ensure full use of Utilization Review on all treatment requests and on-going treatment plans.
Aggressively pursue settlement on all files.
Manage active and stable BMU files, and maintenance only subrogation files.
PRIMARY DUTIES:
Perform telephonic case management of Workers Compensation claims that are assigned.
Manage files with an emphasis on file quality (including timely medical management and proper documentation), maximizing internal resources, and achieving a positive end result by administrative closure or settlement.
Build strong partnership with our internal nurse resources (Medical Case Manager) in order to integrate the delivery of medical services to the injured worker.
Identify claim issues as they arise, and take appropriate steps to resolve them or refer them to the Unit Manager for reassignment.
Establish appropriate reserves to reflect claim exposure.
EDUCATION/COURSE OF STUDY:
High school diploma and some college preferred
WORK EXPERIENCE:
Workers Compensation claim environment handling clerical duties or technical claims
OTHER:
Command of T-Mate, Word, Excel and applicable coverage systems.
Prefer minimum of 1 year experience in a workers¿ compensation claim department
Excellent oral and written communication skills.
Excellent customer service skills.
Excellent organizational skills
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Travelers is an equal opportunity employer. We actively promote a drug-free workplace.
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