Senior Claim Examiner I, CA

AmTrust Financial Services, Inc.; United States; On-site; USD 68,000 - 74,000; Full time

Benefits offered by this job

Medical & Dental plans

Life Insurance for dependents

Health Care Flexible Spending

Dependent Care

401k Savings Plans

Paid Time Off

Job summary

AmTrust Financial Services, Inc. is seeking a Resolution Examiner specializing in workers' compensation claims. You will negotiate settlements, review coverage issues, and coordinate with medical resources to ensure timely, cost-effective resolutions.

The role requires strong negotiation, investigative, and evaluative skills, with experience in handling complex claims and travel as needed.

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.

Responsibilities

• Proactively negotiate settlements for workers' compensation claims, ensuring fair and expedient resolutions.
• Conduct thorough investigations by engaging with insured representatives, claimants, and witnesses.
• 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 manage treatment plans and billing during settlements.
• Collect and evaluate essential documentation to strengthen negotiation positions.
• Utilize critical thinking to assess claims and develop settlement tactics.
• Maintain clear, concise documentation in claims files and communications.

Skills

Negotiation

Investigation

Evaluation

Communication

Travel willingness

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.

• 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.