Senior Workers Compensation Claim Examiner

AmTrust Financial Services, Inc.; Irvine (CA); On-site; USD 62,000 - 74,000; Full time

Benefits offered by this job

Medical & Dental Plans

Life Insurance

401k Savings Plans

Paid Time Off

Job summary

AmTrust Financial Services, Inc. in Irvine, California seeks an experienced Senior Claim Examiner to manage complex workers’ compensation claims from start to resolution, ensuring compliance with state regulations and delivering exceptional service.

You will investigate claims, set reserves, negotiate settlements, and mentor junior examiners. Requires 5+ years of workers’ compensation claims experience and strong technical knowledge. Competitive benefits offered.

Qualifications

• 5+ years of workers’ compensation claims experience.
• Strong verbal and written communication skills.
• Ability to prioritize work load 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 claim validity under applicable workers’ comp statutes and developing treatment plans in collaboration with providers.
• Reviewing and analyzing medical bills to ensure they relate to the workers’ comp injury and treatment plan.
• Ensuring timely payments for medical bills and income replacement per fee schedules and statutes.
• Answering questions regarding claim status from claimants, policyholders, and medical providers.
• Consulting with attorneys regarding litigation management, settlement strategy, and claim resolution.

Skills

MS Office

Verbal & written communication

Prioritize workload

Multitasking

Job description

We are seeking an experienced Workers’ Compensation professional to join our California 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 California.

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 $45 an hour -$54 an hour.

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. Our benefits include: 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.