Senior Workers' Comp Claim Negotiator

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

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