Senior Claim Examiner I

AmTrust Financial Services Inc.; Florida; On-site; USD 60,000 - 90,000; Full time

Job summary

AmTrust Financial Services Inc. in Florida seeks a Senior Claim Examiner to manage complex workers' compensation claims from start to resolution, ensuring compliance with state regulations while delivering exceptional service.

You will investigate claims, determine compensability, set reserves, and negotiate settlements; mentor junior examiners; collaborate with medical providers and attorneys to drive timely results in a fast-paced environment.

Qualifications

• 5+ years of workers' compensation claims experience.
• Strong technical knowledge in workers' comp.
• MS Office proficiency (Word, Excel, Outlook).

Responsibilities

• Investigate workers' compensation claims and determine validity.
• Review medical bills to ensure relation to WC and treatment plan.
• Ensure timely payments of medical bills and wage replacement.
• Respond to inquiries from claimants, policyholders, and providers.
• Consult with attorneys on litigation management, settlements.

Skills

Negotiation skills

Verbal and written communication

Prioritization

Multitasking

Tools

MS Word

MS Excel

MS Outlook

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