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 Description Summary**
Job Description Summary
If passion, reliability, and dedication are part of your DNA,
this is the job for you!
Passion: You are passionate about helping others and maintain a
sense of urgency for our customers when they reach out for
Reliability: You combine understanding with medical and
technical skills to provide service our customers know they can
Dedication: Your dedication is clearly demonstrated throughout
each phase of the workers' compensation claims process.
If you are looking for a job that offers the same opportunity to
make a difference without the demands of working nights, weekends
or holidays, you'll want to explore your next move with us!
In this role you will under moderate supervision, provide office
based telephonic medical case management with emphasis on early
intervention, return to work planning, coordination of quality
medical care on claims involving disability and medical treatment
as well as in-house medical reviews as applicable to claim handling
laws and regulations. You will be responsible for helping to ensure
injured parties receive appropriate treatment directly related to
the compensable injury or assist claim handlers in managing medical
treatment to an appropriate resolution. 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, if needed, will be
provided at such time as your candidacy is deemed appropriate for
**Primary Job Duties & Responsibilities**
+ 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
+ Partner with Claim Professional to provide input on medical
treatment and recovery time to assist in evaluating appropriate
+ Submit accurate billing documentation on all activities as
outlined in established guidelines.
+ Customer Engagement.
+ Participate in Telephonic and/or onsite File Reviews.
+ Respond to inquiries - oral and written.
+ Keep injured worker apprised of claim status.
+ In-person medical case management may be required to support
Concierge locations, where a Nurse Case Manager meets with injured
employees face to face following office visits at a provider's
+ In order to perform the essential functions of this job,
acquisition and maintenance of Insurance License(s) and/or
certifications may be required to comply with state and Travelers
requirements. Generally, License(s) are required to be obtained
within three months.
+ Registered Nurse; Licensed Practical Nurse or Licensed
Vocational Nurse required.
**Education, Work Experience, & Knowledge**
+ RN highly preferred.
+ Disability case management experience preferred.
+ Prior clinical experience preferred.
+ Strong Microsoft Office skills preferred.
+ Spanish speaking bi-lingual is a plus!
**Licensing or Certificates**
+ Certified Case Manager (CCM), Certified Disability Management
Specialist (CDMS), Clinical Research Counselor (CRC), or Certified
Rehab Registered Nurse (CRRN) preferred.
**Job Specific Technical Skills & Competencies**
+ Familiarity with URAC standards
+ Analytical Thinking: Identifies current or future problems or
opportunities; analyzes, synthesizes and compares information to
understand issues; identifies cause/effect relationships; and
explores alternative solutions that support sound
+ Communication: Expresses, summarizes and records thoughts
clearly and concisely orally and in writing by applying proper
content, format, sentence structure, grammar, language and
terminology. Ability to effectively present file resolution to
internal and/or external stakeholders.
+ Negotiation: Intermediate ability to understand alternatives,
influence stakeholders and reach a fair agreement through
discussion and compromise.
+ General Insurance Contract Knowledge: Ability to understand
policies and contracts, as they apply to policy conditions.
+ Principles of Investigation: Intermediate investigative
skills. Follows a logical sequence of inquiry with a goal of
securing information about the work accident, resulting injury,
anticipated treatment, job duties and any material factors that may
impact recovery and return to work.
+ Value Determination: Basic ability to determine liability and
assigns a dollar value based on damages claimed and estimates, sets
and readjusts reserves.
+ Legal Knowledge: 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.
+ Medical knowledge: Thorough knowledge of the nature and extent
of injuries, periods of disability, and treatment needed.
+ WC Technical: 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. Demonstrate a clear understanding and ability to
work within jurisdictional parameters within their assigned
+ Customer Service: Advanced ability to build and maintain
productive relationships with our insureds and deliver results with
+ Teamwork: Advanced ability to work together in situations when
actions are interdependent and a team is mutually responsible to
produce a result.
+ Planning & Organizing: Advanced ability to establish a
plan/course of action and contingencies for self or others to meet
current or future goals.
**Environmental / Work Schedules / Other**
+ Travel Requirements: Travel Occasionally
Travelers is an equal opportunity employer. We value the unique
abilities and talents each individual brings to our organization
and recognize that we benefit in numerous ways from our
If you are a candidate and have specific questions regarding the
physical requirements of this role, please send us an email
(4-ESU@travelers.com) 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.