Lead Claim Examiner I

AmTrust Financial Services Inc.; Chicago (IL); Hybrid; USD 77,500 - 87,000; Full time

Benefits offered by this job

Medical & Dental Plans

Life Insurance

401k Savings Plans

Paid Time Off

Job summary

AmTrust Financial Services is seeking a Lead Claims Examiner to promptly investigate, evaluate, and settle or decl ine workers' compensation claims through research, negotiation with insureds, claimants, and medical providers.

The position starts remotely, with a transition to a hybrid schedule once the Oakbrook IL office opens, offering a path to collaborative oversight with internal counsel and medical resources to optimize return-to-work strategies.

Qualifications

• 3+ years experience as a Workers Comp adjuster
• MS Office experience (Work, Excel, Outlook)
• Effective negotiation skills
• Strong verbal and written communication skills
• Ability to prioritize workload to meet deadlines
• Ability to manage multiple tasks in a fast-paced environment

Responsibilities

• Follows AmTrust policies and procedures in managing claims.
• Investigates the claim and coverage by contacting involved parties including insured, claimant, witnesses and medical providers.
• Evaluates, establishes, maintains and adjusts reserves based on facts and experience.
• Negotiates claims to achieve quick resolution while maintaining credibility with all parties.
• Gathers, analyzes and interprets information to identify key issues impacting claims.
• Coordinates with internal counsel to oversee defense plans and manages costs with legal support.
• Communicates with managed care and medical resources to support return-to-work plans and treatments.
• Obtains medical records and other required reports.
• Documents communications clearly in claims files and related systems.
• Delivers exceptional customer service and supports other duties as needed.

Skills

Negotiation

Communication

Time management

Multitasking

Education

Tools

MS Office

Job description

Overview

The Lead Claims Examiner is 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.

This position will start remotely with an expectation to transition to a hybrid schedule upon opening of our Oakbrook IL office.

Responsibilities

• Follows AmTrust policies and procedures in managing claims.
• Investigates the claim and coverage by making timely and appropriate contact with involved or interested parties including but not limited to the insured, claimant, witnesses and medical providers.
• Evaluates, establishes, maintains and adjusts reserves based on fact, company standard and experience.
• Skillfully negotiates claims, turning adverse perspectives into quick resolution. Gains trust of other parties to negotiations and demonstrates good sense of timing. Approaches discussions from merits or strengths of case.
• Leverages strong critical thinking and decision-making skills to gather, assess, analyze, question, verify, interpret and understand key or root issues.
• Establishes effective relationships with internal or assigned counsel for customized defense plan. Applies company principles and standards including planning, organizing and monitoring legal panel services and cost in partnership with internal legal counsel.
• Communicates with internal managed care and medical resources to ensure coordination with medical providers, injured workers and employers in developing return to work strategies and treatment plans.
• Obtain medical records (past and present), police, ambulance and other agency reports as required.
• Provides insights and input when reviewing claims of others. May be sought out by others for advice.
• Writes in a clear, succinct and fact-based manner in claims files as well as in other communication.
• Manages mail and diary entries effectively and efficiently.
• Provides exceptional customer service.
• Performs other functional duties as requested or required.

Qualifications

Required:

• 3+ years experience as a Workers Comp adjuster
• 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

This job description is designed to provide a general overview of the requirements of the job and does not entail a comprehensive listing of all activities, duties, or responsibilities that will be required in this position. AmTrust has the right to revise this job description at any time

The expected salary range for this role is $77,500-87,000 annual.

Please note that the salary information shown above is a general guideline only. Salaries are based upon a wide range of factors considered in making the compensation decision, including, but not limited to, candidate skills, experience, education and training, the scope and responsibilities of the role, as well as market and business considerations

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.