Senior Claim Examiner I

AmTrust Financial Services Inc.; Inwood (TX); On-site; USD 65,000 - 90,000; Full time

Job summary

AmTrust Financial Services Inc. in Texas seeks a Senior Claim Examiner to manage complex workers' compensation claims from start to resolution, ensuring regulatory compliance and high service standards.

The role emphasizes investigation, reserving, settlement negotiations, and collaboration with attorneys, medical providers, and claimants; mentoring junior staff and maintaining accuracy and timely payments.

Qualifications

• 5+ years in workers' compensation claims preferred.
• Strong negotiation and communication abilities.
• Ability to work in fast-paced environment.
• Experience investigating and resolving high-exposure claims.

Responsibilities

• Investigate claims, determine compensability, and set reserves.
• Review medical bills for relation to workers' comp.
• Ensure timely payments of bills and wage replacement.
• Coordinate with attorneys on litigation and settlements.
• Mentor junior examiners as needed.

Skills

Negotiation skills

Verbal & written communication

Prioritization

Multitasking ability

Strong analytical skills

Tools

MS Office (Work, Excel, 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