Senior Workers Compensation Claim Examiner

AmTrust Financial Services, Inc.; Florida; On-site; USD 65,000 - 85,000; Full time

Benefits offered by this job

Medical & Dental Plans

Life Insurance for spouses & children

Health Care Flexible Spending

Dependent Care

401k Savings Plans

Paid Time Off

Job summary

AmTrust Financial Services in Florida is seeking a Senior Claim Examiner to manage complex workers’ compensation claims from start to resolution. You will investigate, determine compensability, set reserves, and negotiate settlements, while mentoring junior examiners and ensuring compliance with state regulations.

The role requires 5+ years of workers’ compensation claims experience and strong communication skills to coordinate with injured workers, providers, and attorneys, in a fast-paced

Qualifications

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

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 and communicating with medical providers.
• Reviewing and analyzing medical bills to confirm relation to the injury and adherence to the treatment plan.
• Ensuring payments for medical bills and income replacement are remitted timely.
• Answer questions regarding status of pending claims from claimants, policyholders and medical providers.
• Consult with attorneys regarding litigation management, settlement strategy and claim resolution.

Skills

Strong verbal and written comms

Prioritize workload

Manage multiple tasks

5+ years WC claims experience

Tools

MS Office

Job description

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

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.