Senior Claim Examiner I, CA

AmTrust Financial Services Inc.; Los Angeles (CA); On-site; USD 68,000 - 74,000; Full time

Job summary

AmTrust Financial Services is seeking a Resolution Examiner with expertise in workers' compensation claims for Los Angeles. The role centers on negotiating and resolving claims efficiently while controlling costs, including independent review of coverage, settlements, and liaison with insureds, claimants, and legal representatives.

Responsibilities include proactive settlement negotiations, thorough investigations, reserves, and collaboration with medical resources to ensure proper treatment and

Qualifications

• Bachelor's degree or equivalent experience.
• Minimum of 3 years of experience handling and settling workers' compensation claims.
• State licensure as required.
• Proficiency with MS Office Suite and claims management software.
• Strong negotiation, investigation, and evaluation skills specific to workers' compensation claims.

Responsibilities

• Proactively negotiate settlements for workers' compensation claims, ensuring fair and expedient resolutions.
• Conduct thorough investigations by engaging with insured representatives, claimants, and witnesses to gather critical information.
• Analyze coverage issues and the applicability of benefits under relevant policies and statutes.
• Establish and adjust reserves based on projected claim outcomes.
• Collaborate with internal Managed Care and Medical resources to ensure treatment plans and billing are managed effectively.
• Collect and evaluate essential documentation, including medical records and incident reports.
• Utilize critical thinking to assess claims and develop negotiation tactics for optimal settlements.
• Maintain clear documentation in claims files and communications.
• Manage time effectively to meet deadlines and client expectations.
• Build and maintain relationships with customers throughout the settlement process.
• Conduct compensability analysis based on AOE/COE investigations.

Skills

Negotiation

Investigation

Evaluation

Communication

Education

Bachelor's degree or equivalent experience

Tools

MS Office Suite

Claims management software

Job description

Overview

AmTrust is actively seeking a skilled Resolution Examiner specializing in Workers' Compensation Claims. The primary focus will be on negotiating and settling claims efficiently and at a cost effective value. In this role, you will be entrusted with the independent review and resolution of workers' compensation claims; utilizing your expertise in negotiation and settlement strategies to bring claims to resolution posture. Your ability to effectively interact with insureds, claimants, and their legal representatives will be essential in driving timely settlements while adhering to AmTrust's mission, vision, and values.

Responsibilities

• Proactively negotiate settlements for workers' compensation claims, ensuring fair and expedient resolutions that meet the needs of all parties involved.
• Conduct thorough investigations by engaging with insured representatives, claimants, and witnesses to gather critical information that supports settlement discussions.
• Analyze coverage issues and the applicability of benefits under relevant policies and statutes to facilitate informed negotiation outcomes.
• Establish and adjust reserves based on projected claim outcomes, ensuring alignment with corporate standards and settlement strategies.
• Collaborate closely with internal Managed Care and Medical resources to ensure that treatment plans and billing are managed effectively during the settlement process.
• Collect and evaluate essential documentation, including medical records and incident reports, to strengthen negotiation positions and expedite settlements.
• Utilize critical thinking and decision-making skills to assess claims and develop effective negotiation tactics aimed at achieving optimal settlement outcomes.
• Maintain clear, concise, and factual documentation in claims files and communications, supporting transparency throughout the settlement process.
• Manage time effectively, prioritizing negotiations and settlements in a fast-paced environment to meet deadlines and client expectations.
• Build and maintain strong relationships with customers, fostering their trust and confidence throughout the claims settlement process.

Unique Responsibilities:

• Conduct compensability analysis based on AOE/COE investigations to identify valid claims and streamline settlement negotiations.
• Verify the nature and extent of injuries, adapting settlement strategies based on changes in claim exposure.
• Leverage a high level of technical knowledge in workers' compensation claims to facilitate effective and timely settlements.
• Exhibit exceptional communication skills, both written and oral, to professionally engage with all stakeholders involved in the claims process.
• Adapt to changing circumstances and priorities, demonstrating flexibility in negotiations to achieve the best outcomes.

Qualifications

• Bachelor's degree or equivalent experience.
• Minimum of 3 years of experience in handling and settling workers' compensation claims.
• Preferred experience in negotiating litigated or complex claims.
• State licensure as required.
• Proficiency with MS Office Suite and claims management software.
• Strong negotiation, investigation, and evaluation skills specific to workers' compensation claims.
• In-depth knowledge of workers' compensation laws and insurance practices.
• Ability to travel, as required for some positions.

Preferred Qualifications:

• Multijurisdictional experience may be required.
• CPCU, ARM, AIC, or other relevant claims certifications are preferred.

The expected salary range for this role is $49/hr-$54/hr

Please note that the salary information shown above is a general guideline only. Salaries are based upon a wide range of factors considered in making the compensation decision, including, but not limited to, candidate skills, experience, education and training, the scope and responsibilities of the role, as well as market and business considerations

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.