Claims Examiner, Medical Only

AmTrust Financial Services, Inc.; Princeton (NJ); Hybrid; USD 65,000 - 85,000; Full time

Benefits offered by this job

Medical & Dental Plans

Life Insurance

Health Care Flexible Spending

Dependent Care

401k Savings Plans

Paid Time Off

Job summary

AmTrust Financial Services is seeking a Workers’ Compensation Medical Only Claims Examiner to investigate medical-only workers’ compensation claims. This hybrid role is based in Princeton, NJ, requiring coordination with claimants, employers, medical providers and underwriters to ensure timely, appropriate treatment while controlling costs.

You will verify coverage, establish medical reserves, authorize treatment, review bills and maintain accurate case notes.

Qualifications

• Proficiency with MS Word and Excel.
• Strong critical thinking and independent decision making.
• State licensing requirements (if applicable).

Responsibilities

• Investigates low to moderate severity losses to determine cause and extent of injury/liability.
• Verifies policy coverage and confirms policy conditions.
• Obtains missing information and ensures data integrity for regulatory reporting.
• Communicates with claimants, policyholders, underwriters, agents and providers.
• Authorizes medical treatment and schedules medical appointments.
• Establishes medical reserves and reviews medical bills.
• Documents all correspondence and decisions in the claim file.
• Knowledge of multi-state workers' compensation jurisdictions.
• Performs other related duties as assigned.

Skills

MS Word

MS Excel

Critical thinking

Independent decision making

State licensing requirements

Job description

The Workers’ Compensation Medical Only Claims Examiner is responsible for the prompt and effective investigation of workers’ compensation claims involving injuries requiring medical treatment without lost wages. Claim adjudication requires interaction with employers, claimants, medical providers, and other parties to ensure adequate medical treatment is provided utilizing company resources in a cost-effective manner.

Note, this is a hybrid opportunity out of our Princeton, NJ office.

Responsibilities

• Ability to multitask and prioritize work in a fast-paced environment and manage time effectively
• Investigates losses of low to moderate severity to determine cause, scope and extent of injury and/or liability for potential subrogation
• Verifies coverage and confirms policy conditions have been met
• Obtains missing information and ensures data integrity for regulatory reporting
• Communicates effectively with claimants, policyholders, underwriters, agents, and other internal and external stakeholders
• Authorizes medical treatment and schedules medical appointments
• Establishes medical reserves, approves medical bills and reviews/requests medical records
• Documents all correspondence, reports, discussions, and decisions in claim file notes
• Knowledge of multi-state jurisdictions (if applicable)
• Performs other related duties as assigned

Qualifications

Required

• Proficiency with MS Word, Excel, and other business applications
• Demonstrated skills in critical thinking and independent decision making
• State licensing requirements (if applicable)

Preferred

• Minimum of 2 years handling Medical Only or other Workers’ Compensation claims experience
• Basic knowledge of medical conditions, treatment plans and casual relation to occupational injury/illness
• Drive and desire to use this position as a starting point to potentially enter the Claim Associate training program and become a lost time adjuster in the future

What We Offer

AmTrust Financial Services offers a competitive compensation package and excellent career advancement opportunities.

Our benefits include:

• Medical & Dental Plans
• Life Insurance, including eligible spouses & children
• Health Care Flexible Spending
• Dependent Care
• 401k Savings Plans
• Paid Time Off

AmTrust strives to create a diverse and inclusive culture where thoughts and ideas of all employees are appreciated and respected. This concept encompasses but is not limited to human differences with regard to race, ethnicity, gender, sexual orientation, culture, religion or disabilities.

AmTrust values excellence and recognizes that by embracing the diverse backgrounds, skills, and perspectives of its workforce, it will sustain a competitive advantage and remain an employer of choice. Diversity is a business imperative, enabling us to attract, retain and develop the best talent available. We see diversity as more than just policies and practices. It is an integral part of who we are as a company, how we operate and how we see our future.