Claims Adjuster III - Workers Compensation
Claims Adjuster III - Workers Compensation
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Job Description
Overview
Assigned to our Workers Compensation Line of Business the Adjuster III is responsible for prompt and independent review of insurance claims through effective research evaluation investigation negotiation and interaction with insureds or claimants. The Adjuster III is often assigned to midsize or mid complexity claims in the Line of Business. Maintains a solid understanding of AmTrusts mission vision and values. Upholds the standards of the AmTrust and Claims organization.Experience handling Workers Compensation Claims is required for this position.
Responsibilities
- Investigates the claim or coverage by making timely and appropriate contact with involved or interested parties including but not limited to the insured or employer representatives claimant or injured workers witnesses and producers.
- Analyzes coverage that may or may not be applicable to the claim by policy or statutes. Reviews coverage issues as needed with supervisor and drafts positions as required.
- Establishes reserves based on estimating most likely outcome of a claim based on the facts for the case and company standard. Adjust reserves based on facts company standard and experience.
- Occasionally claims adjusted by an Adjuster II will involve working with internal or assigned Legal Counsel. Build strong relationships applying company principles and standards in partnership with internal legal counsel.
- Effectively negotiates nonlitigated claims. Gains trust of other parties to negotiations and demonstrates good sense of timing.
- Depending on the type of claim may:
- Communicate with internal Managed Care and Medical resources to ensure coordination with Medical providers on the development and authorization of appropriate treatment plans as well as accurate billing.
- Obtain medical records and reports police ambulance and agency reports; photographs and measurements.
- Leverages and builds critical thinking and decisionmaking skills to gather assess analyze question verify interpret and understand key or root issues.
- Writes in a clear succinct and factbased manner in Claims files as well as in other communication.
- Demonstrates ability to learn technical materials and learns from mistakes.
- Manages time and diary entries effective and efficiently prioritizing work in a fastpaced environment.
- Establishes and maintains effective relationships with customers and gains their respect and trust.
- Performs other functional duties as requested or required.
Qualifications
- Bachelors degree or equivalent experience
- 3 years claims handling experience Workers Compensation specific
- State licensure as required
- Demonstrated proficiency with MS Office suites
- Demonstrated skills in investigation evaluation and negotiation
- Strong knowledge of insurance theory and practices
- Ability to travel is required for some positions
Preferred:
- Licensure inTexas Louisiana OklahomaArizona
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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.
Employment Type
Full-Time
