Senior Claim Examiner I

AmTrust Financial Services, Inc.; New York (NY); On-site; USD 70,000 - 90,000; Full time

Benefits offered by this job

Medical & Dental Plans

Life Insurance

401k Savings Plans

Paid Time Off

Job summary

AmTrust Financial Services, Inc. is seeking a Lead Claim Examiner to investigate, evaluate and settle or declinate insurance claims with promptness and professionalism.

The role requires strong negotiation, communication, and decision-making skills to manage reserves and coordinate with medical providers and stakeholders. The candidate will engage with insureds, claimants, and providers, maintaining clear documentation and delivering exceptional customer service while navigating fast-paced

Qualifications

• 3+ years experience as a Workers Comp adjuster.
• 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.

Responsibilities

• 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.
• Gleans input from internal or assigned counsel for customized defense plan 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.
• Obtains medical records (past and present), police, ambulance and other agency reports as required.
• Writes in a clear, succinct and fact-based manner in claims files as well as in other communication.
• Provides exceptional customer service.

Skills

Negotiation skills

Verbal and written communication

Prioritization

Multitasking

Tools

MS Office

Job description

Overview

The Lead Claim Examiner 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. 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

• 3+ years experience as a Workers Comp adjuster
• 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

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.