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About the Role
We are seeking experienced professionals to join our Workers’ Compensation team in two key roles: Senior Claim Examiner and Lead Claim Examiner. Both positions play a critical role in managing workers compensation claim files and ensuring compliance with state regulations while delivering exceptional service.
Responsibilities
- Manage complex and high-exposure workers’ compensation claims from start to resolution.
- Investigate claims, determine compensability, set reserves, and negotiate settlements.
- Serve as a resource for junior examiners and assist with mentoring.
- Responsible for prompt and efficient investigation, evaluation and settlement or declination of insurance claims through effective research, negotiation and interaction with insureds, claimants and medical providers.
- Maintains a solid understanding of AmTrust’s mission, vision, and values. Upholds the standards of AmTrust and the Claims organization.
- Thoroughly investigating workers’ compensation claims by contacting injured workers, medical providers, and employer representatives.
- Determining if claims are valid under applicable workers’ comp statutes.
- Communicating with medical providers to develop and authorize appropriate treatment plans.
- Reviewing and analyzing medical bills to confirm charges and treatment are workers’ comp injury-related and in accordance with the treatment plan.
- Ensuring payments for medical bills and income replacement are remitted on a timely basis in accordance with applicable fee schedules and statute.
- Answer questions regarding the status of pending claims from claimants, policyholders and medical providers.
- Consult with attorneys regarding litigation management, settlement strategy and claim resolution.
Requirements
- Requires 5+ years of workers’ compensation claims experience and strong technical knowledge.
- Requires 3+ years of workers’ compensation claims experience and strong technical knowledge.
- MS Office experience (Work, Excel, Outlook)
- Effective negotiation skills
- Strong verbal and written communication skills
- Ability to prioritize work load to meet deadlines
- Ability to manage multiple tasks in a fast-paced environment
Skills
- Workers’ compensation claims management
- Claim investigation
- Compensability determination
- Reserve setting
- Negotiation
- Mentoring
- Medical treatment plan authorization
- Medical bill analysis
- Payment processing
- Litigation management
- MS Office (Work, Excel, Outlook)
- Communication skills
- Prioritization
- Time management
Experience Level
- Senior
- Lead
About the Company
- AmTrust’s mission, vision, and values.