We are seeking experienced professionals to join our Workers’ Compensation team as a Senior Claim Examiner. Both positions play a critical role in managing workers compensation claim files and ensuring compliance with state regulations while delivering exceptional service.
Senior Claim Examiner
- 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.
- Requires 5+ years of workers’ compensation claims experience and strong technical knowledge.
Responsibilities
- 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.
Qualifications
- 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 Required
- 5+ years of workers' compensation claims experience
- Strong technical knowledge of workers' compensation claims
- Microsoft Office experience, including Word, Excel, and Outlook
- Effective negotiation skills
- Strong verbal and written communication skills
- Ability to prioritize workload and meet deadlines
- Ability to manage multiple tasks in a fast-paced environment
What We Do
AmTrust Financial Services, Inc., through its subsidiaries, operates as a multinational property and casualty insurance company. Founded in 1998 to provide workers’ compensation insurance to small businesses in the United States, the company now operates in three segments around the globe: Small Commercial Business Insurance, Specialty Risk and Extended Warranty, and Specialty Middle-Market Property and Casualty Program Insurance.
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