Senior Claim Examiner I

AmTrust Financial Services, Inc.; Dallas (TX); On-site; USD 70,000 - 95,000; Full time

Job summary

AmTrust Financial Services, Inc. in Texas seeks an experienced Senior Claim Examiner to manage complex workers' compensation claims from intake to resolution.

You will investigate, determine compensability, set reserves, and negotiate settlements while ensuring regulatory compliance and service excellence. The role includes mentoring junior examiners, coordinating with medical providers, claimants, and policyholders, and collaborating with attorneys on litigation strategy.

Qualifications

• 5+ years of workers' compensation claims experience.
• Strong negotiation and communication skills.
• Ability to prioritize workload and meet deadlines.
• Experience in a fast-paced environment with multiple tasks.

Responsibilities

• Investigate claims, determine compensability, set reserves, and negotiate settlements.
• Manage complex and high-exposure workers' compensation claims from start to resolution.
• Communicate with injured workers, medical providers, and employer representatives.
• Review medical bills to ensure relation to work injury and adherence to plans.
• Collaborate with attorneys on litigation strategy and claim resolution.

Skills

MS Office

Negotiation

Communication

Prioritization

Multitasking

Job description

Overview

We are seeking experienced professionals to join our Workers' Compensation team as a Senior 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.

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