Senior Workers Compensation Claim Examiner

AmTrust Financial Services, Inc.; Colorado; On-site; USD 78,000 - 105,000; Full time

Benefits offered by this job

Medical & Dental Plans

Life Insurance

401k Savings Plans

Paid Time Off

Health Care Flexible Spending

Dependent Care

Job summary

AmTrust Financial Services, Inc. in Colorado is seeking an experienced Senior Claim Examiner to manage complex workers’ compensation claims from start to resolution, investigate, set reserves, negotiate settlements, and mentor junior examiners while ensuring compliance with state regulations.

Ideal candidates have 5+ years WC claims experience and strong MS Office skills with excellent written and verbal communication.

Qualifications

• 5+ years of workers’ compensation claims experience.
• MS Office experience (Word, Excel, Outlook).
• Strong 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 set reserves; negotiate settlements.
• Review medical bills for WC relation and adherence to the treatment plan.
• Ensure timely payments of medical bills and income replacement per fee schedules and statutes.
• Answer questions on claim status from claimants, policyholders, and providers.
• Consult with attorneys on litigation management and settlement strategy.

Skills

WC claims experience

MS Office

Communication

Prioritization

Job description

We are seeking an experienced Workers’ Compensation professional to join our Central Zone Team. This is a critical role in managing workers compensation claim files and ensuring compliance with state regulations while delivering exceptional service for claims within the State of Colorado.

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)
• Strong verbal and written communication skills
• Ability to prioritize work load to meet deadlines
• Ability to manage multiple tasks in a fast-paced environment

The expected salary range for these roles range from $77,500-$105,000 annual.

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.