Lead Claim Examiner I

AmTrust Financial Services Inc.; Plainsboro Township (NJ); Sur place; USD 90 000 - 120 000; Plein temps

Résumé du poste

The Workers' Compensation Examiner Lead at AmTrust Financial Services Inc. leads prompt investigations, evaluations and settlements or declinations of complex workers’ compensation claims.

You will negotiate resolutions, establish reserves, and coordinate with insureds, claimants, medical providers and internal counsel to support effective defense and settlements. You will build relationships with internal teams and manage information flow, ensuring accurate documentation and timely responses

Qualifications

• Bachelor’s degree or equivalent experience.
• 3+ years WC claims handling experience.
• Demonstrated proficiency with MS Office suites.

Responsabilités

• Follows AmTrust policies and procedures in managing claims.
• Investigates the claim and coverage by contacting involved parties.
• Evaluates reserves based on facts and standards.
• Negotiates claims to achieve timely resolution with stakeholders.
• Gathers, assesses, and interprets information to identify root issues.
• Collaborates with internal counsel and legal resources.
• Coordinates with managed care and medical resources for return‑to‑work plans.
• Obtains medical records and other required reports.
• Documents communications clearly in claims files.
• Provides exceptional customer service and support.

Connaissances

WC claims handling

Investigation

Negotiation

MS Office

Communication

Formation

Bachelor’s degree or equivalent experience

Description du poste

Overview

The Workers' Compensation Examiner Lead 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. The Lead Examiner is often, though not always, assigned to larger or more complex claims than an Adjuster I or II. Maintains a solid understanding of AmTrust’s mission, vision, and values. Upholds the standards of AmTrust and the Claims organization.

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

• Bachelor’s degree or equivalent experience
• 3+ years WC claims handling experience
• Demonstrated proficiency with MS Office suites
• Demonstrated skills in investigation, evaluation and negotiation
• Strong knowledge of insurance theory and practices