Lead Claim Examiner I

AmTrust Financial Services Inc.; Plainsboro Township (NJ); Hybrid; USD 90,000 - 120,000; Full time

Benefits offered by this job

Medical & Dental Plans

401k Savings Plans

Paid Time Off

Job summary

AmTrust Financial Services Inc. is seeking a Workers' Compensation Examiner Lead to drive prompt investigation, evaluation and settlement or declination of complex claims for insureds, claimants and medical providers.

The role sits in our Princeton, NJ office with a four-day hybrid schedule. You will mentor examiners, manage reserves, negotiate settlements, coordinate with defense counsel and medical resources, and ensure timely, accurate file documentation.

Qualifications

• Bachelor’s degree or equivalent experience.
• 5+ years WC claims handling experience.
• Strong MS Office proficiency.
• Proven investigation, evaluation and negotiation skills.

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 fact, company standard and experience.
• Skillfully negotiates claims and facilitates quick resolutions with adversaries.
• Gathers and analyzes information to identify root issues and supports defense strategies.
• Coordinates with in-house counsel and legal services for cost-effective outcomes.
• Communicates with managed care and medical resources to support return-to-work plans.
• Obtains medical records, police and other agency reports as required.
• Writes clear, factual notes and summaries in claims files and communications.
• Manages mail, diary entries and documentation efficiently.
• Provides exceptional customer service.
• Performs other duties as requested.

Skills

Investigation

Negotiation

Reserving & Evaluation

Communication

Analytical Thinking

Education

Bachelor’s degree or equivalent experience

Tools

MS Office

Job description

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.

This position will sit 4 days hybrid out of our Princeton NJ 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

• Bachelor’s degree or equivalent experience


• 5+ 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

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.