Senior Claim Examiner II, CA
Senior Claim Examiner II, CA
Employer Active
Job Alert
You will be updated with latest job alerts via email
Share
Job Alert
You will be updated with latest job alerts via email
Job Description
Overview
AmTrust is actively seeking a skilled Resolution Examiner specializing in Workers Compensation Claims. The primary focus will be on negotiating and settling claims efficiently and at a cost effective this role you will be entrusted with the independent review and resolution of workers compensation claims; utilizing your expertise in negotiation and settlement strategies to bring claims to resolution posture. Your ability to effectively interact with insureds claimants and their legal representatives will be essential in driving timely settlements while adhering to AmTrusts mission vision and values.
Responsibilities
Responsibilities:
- Proactively negotiate settlements for workers compensation claims ensuring fair and expedient resolutions that meet the needs of all parties involved.
- Conduct thorough investigations by engaging with insured representatives claimants and witnesses to gather critical information that supports settlement discussions.
- Analyze coverage issues and the applicability of benefits under relevant policies and statutes to facilitate informed negotiation outcomes.
- Establish and adjust reserves based on projected claim outcomes ensuring alignment with corporate standards and settlement strategies.
- Collaborate closely with internal Managed Care and Medical resources to ensure that treatment plans and billing are managed effectively during the settlement process.
- Collect and evaluate essential documentation including medical records and incident reports to strengthen negotiation positions and expedite settlements.
- Utilize critical thinking and decision-making skills to assess claims and develop effective negotiation tactics aimed at achieving optimal settlement outcomes.
- Maintain clear concise and factual documentation in claims files and communications supporting transparency throughout the settlement process.
- Manage time effectively prioritizing negotiations and settlements in a fast-paced environment to meet deadlines and client expectations.
- Build and maintain strong relationships with customers fostering their trust and confidence throughout the claims settlement process.
Unique Responsibilities:
- Conduct compensability analysis based on AOE/COE investigations to identify valid claims and streamline settlement negotiations.
- Verify the nature and extent of injuries adapting settlement strategies based on changes in claim exposure.
- Leverage a high level of technical knowledge in workers compensation claims to facilitate effective and timely settlements.
- Exhibit exceptional communication skills both written and oral to professionally engage with all stakeholders involved in the claims process.
- Adapt to changing circumstances and priorities demonstrating flexibility in negotiations to achieve the best outcomes.
Qualifications
Qualifications:
- Bachelors degree or equivalent experience.
- Minimum of 3 years of experience in handling and settling workers compensation claims.
- Preferred experience in negotiating litigated or complex 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.
- In-depth knowledge of workers compensation laws and insurance practices.
- Ability to travel as required for some positions.
Preferred Qualifications:
- Multijurisdictional experience may be required.
- CPCU ARM AIC or other relevant claims certifications are preferred.
Salary:
The salary range for this role is $43-$49/hourapplicable for jobs performed in California. Base pay may vary based on education experience skills geographic location travel requirements and sales or revenue-based metrics. This range is subject to future modifications.
Join Us:
If you are a dedicated claims adjuster with a strong focus on settlements and a passion for achieving optimal resolutions in workers compensation claims we invite you to apply today. Become an integral part of AmTrusts commitment to excellence in claims management!
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.
Required Experience:
Senior IC
Employment Type
Full-Time
