Senior Claim Examiner I

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.

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.

Lead Claim Examiner: 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. Requires 3+ 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