Job Title or Location

Accident Benefit Claim Representative, Minor Injury Guideline

The Travelers Companies, Inc. - 6 Jobs
Oakville, ON
Posted today
Job Details:
Full-time
Entry Level
Benefits:
Health Insurance
Paid Time Off
Stock/Profit Share

Who Are We?

Solid reputation, passionate people and endless opportunities. That's Travelers. 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.

Target Openings

3

What Is the Opportunity?

Under close supervision, this position is responsible for investigating and evaluating, primarily low to moderate complexity claims, to determine coverage available to policyholders and claimants. This role is responsible for handling 1st party Personal Insurance and Business Insurance AB claims. In adherence to legislation and regulations, the role applies policy and company guidelines to all claims to manage loss costs and customer relations. The AB role handles a wide variety of causes of loss and occasionally handles claims with complexities related to unique coverage and/or damage issues. This position does not manage staff.

What Will You Do?

Deliver consistent quality service throughout the claim life cycle, includes but not limited to prompt contact, explanation of the process, set expectations, on-going communication, follow-through and meeting commitments to achieve optimal outcome on every file. Fulfill specific service commitments made to certain accounts, as outlined in Special Account Communication (SAC), where applicable.
Review and analyze coverage and applies policy conditions, provisions, exclusions and endorsements for assigned jurisdictions. Verify the benefits available, the injured party's eligibility and the applicable limits. Address proper application of any deductibles, collateral benefits, coverage limits, etc. Confirm priority of payments (ie. the correct insurer to cover the claim) and take into consideration other issues such as Social Security, Workers Compensation or others relevant to the jurisdiction.
Investigate each claim to obtain relevant facts necessary to determine coverage, causation/injury, medical necessity, treatment plan, other losses, and exposure with respect to the various coverages provided through prompt contact with appropriate parties (e.g. policyholders, claimants, counsel, medical providers and technical experts). This may also include investigation of wage loss and ongoing employment. Take recorded or written statements as necessary.
Proactively manage medical treatment based on the nature and extent of injury, mechanism of injury, type of treatment received or anticipated, and wage loss, utilize experts and/or medical resources as deemed necessary. Proactively manage the process to ensure proper payment, (i.e. review invoices and medical records for appropriateness of billing/fees and the services rendered to ensure that all records have a determination of medical necessity and causal relationship to the loss).
Establish appropriate and timely reserves and maintain appropriate loss and expense reserves to reflect the overall claim exposure. Manage file inventory and reserves by utilizing an effective diary system and document claim file activities to resolve claims in a timely manner.
Determine settlement amounts, negotiates, and conveys claim settlements within provided authority limits to claimants. As appropriate, writes denial letters, Reservation of Rights and other necessary correspondence to insureds and claimants.
May handle litigated files on appropriately assigned cases. Develop a resolution plan with staff or panel counsel, and track and control legal expenses. Review conciliations and prepare submissions for relevant arbitration and/or LAT/mediation hearings. May also attend arbitrations or other meetings as a company witness, when appropriate, necessary, and required.
Perform other duties as assigned.

What Will Our Ideal Candidate Have?

University Degree/College Diploma or equivalent business experience.
One year previous work experience in insurance claims or health care field.
Enrolment in the CIP program is an asset.
High proficiency with Windows-based programs including spreadsheet and word-processing applications.
Strong verbal and written communications skills.
Proficiency in interpersonal communication, both via telephone and in written correspondence such as letters and emails.
Ability to understand and apply legislation, regulations, policies and procedures.
Excellent organizational skills with ability to work independently.
Strong analytical and decision making skills.
Strong focus on customer service with a high level of empathy.
Proven dedication and a customer-centric approach in handling all assigned responsibilities
Strong negotiation skills.
In order to perform the essential job functions of this job, acquisition and maintenance of Insurance License(s) may be required to comply with provincial and Travelers requirements.
Generally, License(s) are required to be obtained within three months of starting the job.

What is a Must Have?

A minimum of one year previous work experience required.
Experience utilizing computer technology; such as Microsoft Office, e-mail, Web-enabled applications, and database software required.
Ability to accurately compute a variety of numerical calculations required.
Licensing Required: In order to perform the essential job functions of this job, acquisition and maintenance of Insurance License(s) may be required to comply with provincial and Travelers requirements.

What Is in It for You?

Health Insurance: Employees and their eligible family members - including spouses, partners, and children - are eligible for coverage from the first day of employment.
Retirement: Travelers provides a core contribution of 3% of your total eligible earnings to your Deferred Profit Sharing Plan ("DPSP"). Travelers also matches your savings plan contribution dollar-for-dollar up to 5% of base pay.
Paid Time Off: Start your career at Travelers with a minimum of 20 days Paid Time Off ("PTO") annually, plus the opportunity to purchase additional days to allow for up to a total of 36 PTO days per year. You will also receive twelve 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 value the unique abilities and talents each individual brings to our organization and recognize that we benefit in numerous ways from our differences.

We are committed to providing accommodation to persons with disabilities. If you require accommodation during the recruitment or interview process we will work with you to accommodate your needs.

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

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