Senior Claim Examiner I, OK

AmTrust Financial Services, Inc.; Overland Park (KS); Vor Ort; USD 70.000 - 90.000; Vollzeit

Zusammenfassung

AmTrust Financial Services Inc. in Overland Park, Kansas, seeks a Senior Claim Examiner to manage complex workers’ compensation claims from start to resolution, ensuring compliance with state regulations and delivering exceptional service.

The role emphasizes investigation, reserving, negotiation of settlements, mentoring junior examiners, and requires 5+ years of workers’ compensation claims experience with strong technical knowledge.

Qualifikationen

• MS Office experience (Word, Excel, Outlook)
• Effective negotiation skills
• Strong verbal and written communication skills
• Ability to prioritize workload and meet deadlines
• Ability to manage multiple tasks in a fast-paced environment

Aufgaben

• Investigate workers’ compensation claims by contacting injured workers, medical providers, and employer representatives; determine validity under applicable statutes.
• Review medical bills to confirm charges are related to the workers’ comp injury and consistent with the treatment plan.
• Ensure timely payments of medical bills and income replacement per fee schedules and statutes.
• 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.

Kenntnisse

Negotiation skills

Verbal & written communication

Prioritize workload

Multitasking

Tools

MS Office

Jobbeschreibung

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