Senior Claim Examiner I

AmTrust Financial Services Inc.; Florida; Hybrid; USD 85,000 - 110,000; Full time

Job summary

AmTrust Financial Services Inc. seeks a Senior Claim Examiner to manage complex workers' compensation claims from start to resolution in New York. You will investigate claims, determine compensability, set reserves, and negotiate settlements, while mentoring junior examiners.

This role requires 5+ years of workers' comp claims experience, strong negotiation and communication skills, and the ability to handle multiple tasks in a fast-paced environment within a compliance-driven setting.

Qualifications

• 5+ years of workers' compensation claims experience.
• Strong negotiation, verbal and written communication skills.
• Ability to prioritize workload and manage multiple tasks in a fast-paced environment.

Responsibilities

• Investigate workers' compensation claims by contacting injured workers, medical providers, and employer representatives; determine compensability and authorize treatment plans.
• Review medical bills to confirm charges and treatment relate to workers' comp and comply with plans.
• Ensure timely payment of medical bills and income replacement per fee schedules and statutes.
• Answer questions on claim status from claimants, policyholders, and medical providers.
• Consult with attorneys on litigation management, settlement strategy and claim resolution.

Skills

Negotiation skills

Verbal communication

Written communication

Prioritization

Task management

Tools

MS Office (Word, 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