First Party Medical Claim Trainee - West Bridgewater, MA

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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 performancebased cash incentive awards.

Salary Range
$44200.00 $72800.00
Target Openings
4
What Is the Opportunity
This position is hybrid 3 days in office 2 days remote out of the West Bridgewater MA office location.

This is an entry level position that requires satisfactory completion of a formal training program to advance to Claim Representative Auto First Party Medical position. This position is intended to develop skills for investigating evaluating negotiating and resolving First Party Medical claims on losses of lesser value and complexity. Provides quality claim handling throughout the claim life cycle (customer contacts coverage investigation evaluation reserving negotiation and resolution) including maintaining full compliance with internal and external quality standards and state specific regulations.

As part of the hiring process this position requires the completion of an online preemployment 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 further consideration.
What Will You Do
Completes required training program which includes the overall instruction exposure and preparation for employees to progress to the next level position. It is a mix of online virtual classroom and onthejob training. The training may require travel.
The on the job training includes practice and execution of the following core assignments:
Participates in ongoing training sessions for the inside auto business.
Works closely with Unit Manager or mentor to promptly resolve assigned claim.
Customer Contacts/Experience:

Delivers consistent service quality throughout the claim life cycle including but not limited to prompt contact explaining the process setting expectations ongoing communication followthrough and meeting commitments to achieve optimal outcome on every file.
Coverage Analysis:

Reviews and analyzes coverage and applies policy conditions provisions exclusions and endorsements for assigned jurisdictions. Verifies the benefits available the injured partys eligibility and the applicable limits. Addresses proper application of any deductibles coinsurance coverage limits etc. Confirms priority of coverage (i.e. primary secondary concurrent) and takes into consideration other issues such as Social Security Workers Compensation or others relevant to the jurisdiction.
Investigation/Evaluation:

Investigates each claim to obtain relevant facts necessary to determine coverage causation/damages medical necessity treatment plan damages and exposure with respect to the various coverages provided through prompt contact with appropriate parties (e.g. policyholders medical providers and technical experts). This may also include investigation of wage loss and essential services claims. Takes recorded statements as necessary.
Reserving:

Establishes timely and maintains appropriate claim and expense reserves to reflect the overall claim exposure. Manages file inventory and expense reserves by utilizing an effective diary system documenting claim file activities to resolve claim in a timely manner.
Negotiation/Resolution:

Determines settlement amounts negotiates and conveys claim settlements within authority limits to insureds and claimants. As appropriate writes denial letters Reservation of Rights and other necessary correspondence to insureds and claimants.
Proactively manages medical treatment based on the nature and extent of injury mechanism of injury type of treatment received or anticipated and wage loss through case management and use of medical resources as needed. Proactively manages the process to ensure proper payment (i.e. review medical bills and medical records for appropriateness of billing/fees and the services rendered ensuring that all records have a determination of medical necessity and causal relationship to the loss).
Insurance License:

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.