Return To Work Case Mgr I

Travelers is a leading property casualty insurer with a commitment to customer care and community support. The Return To Work Case Manager I is responsible for managing Workers' Compensation claims, negotiating settlements, and coordinating medical treatment to facilitate the injured worker's return to work. Responsibilities Conduct investigations, including, but not limited to assessing policy coverage, contacting insureds, injured workers, medical providers, and other parties in a timely manner to determine compensability Establish and update reserves to reflect claim exposure and document rationale. Identify and set actuarial reserves. Apply knowledge to determine causal relatedness of medical conditions Manage files with an emphasis on file quality (including timely contact and proper documentation and proactive resolution of outstanding issues). Achieve a positive end result by returning injured party to work and coordinating the appropriate medical treatment.in collaboration with internal nurse resources where appropriate Work in collaboration with specialty resources (i.e. medical and legal) to proactively pursue claim resolution opportunities, (i.e. return to work, structured settlement, and discontinuation of benefits through litigation). Develop strategies to manage losses involving issues of statutory benefit entitlement, medical diagnoses, Medicare Set Aside to achieve resolution through the best possible outcome Collaborate with our internal nurse resources (Medical Case Manager) in order to integrate the delivery of medical services into the overall claim strategy. Prepare necessary letters and state filings within statutory limits Pursue all offset opportunities, including apportionment, contribution and subrogation. Evaluate claims for potential fraud.Proactively manage inventory with documented plans of action to ensure timely and appropriate file closing or reassignment Effectively manage litigation to drive files to an optimal outcome, including resolution of benefits. Understand and apply Medicare Set Asides and allocations Negotiate settlement of claims within designated authority. May use structured settlement/annuity as appropriate for the jurisdiction 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 Skills High School Diploma or GED 1 year Workers Compensation claim handling experience or successful completion of the WC trainee program 2 years Workers Compensation claim handling experience 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 decision-making 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: Interprets policies and contracts, applies loss facts to policy conditions, and determines whether or not a loss comes within the scope of the insurance contract Principles of Investigation: Intermediate investigative skills including the ability to take statements Follows a logical sequence of inquiry with a goal of arriving at an accurate reconstruction of events related to the loss Value Determination: Intermediate ability to determine liability and assigns a dollar value based on damages claimed and estimates, sets and readjusts reserves Settlement Techniques: Intermediate ability to assess how a claim will be settled, when and when not to make an offer, and what should be included in the settlement offer package Legal Knowledge: General 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: Intermediate 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 resolve claims Demonstrate a clear understanding and ability to work within jurisdictional parameters within their assigned state Intermediate 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 Customer Service: Advanced ability to build and maintain productive relationships with our insureds and deliver results with optimal outcomes 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 Maintain Continuing Education requirements as required or as mandated by state regulations Benefits Health Insurance 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. Company Overview Travelers provides insurance coverage to protect the things that are important to you – your home, your car, your valuables and your business. It was founded in 1853, and is headquartered in New York, New York, USA, with a workforce of 10001+ employees. Its website is Company H1B Sponsorship Travelers has a track record of offering H1B sponsorships, with 75 in 2025, 47 in 2024, 60 in 2023, 42 in 2022, 27 in 2021, 20 in 2020. Please note that this does not guarantee sponsorship for this specific role.