Claim Examiner I

AmTrust Financial Services, Inc.•Spring Valley, NV

73d•$53,300 - $67,000•Hybrid

About The Position

Assigned to Worker's Compensation claims, the Adjuster I is responsible for prompt and independent review of insurance claims through effective research, evaluation, investigation, negotiation and interaction with insureds and claimants. The Adjuster I is often assigned to mid-size or mid complexity claims in the Line of Business. Maintains a solid understanding of AmTrust’s mission, vision, and values. Upholds the standards of the AmTrust and Claims organization. This will be a hybrid position out of our Las Vegas, NV office.

Requirements

Bachelor’s degree or equivalent experience
3+ years claims handling experience
State licensure as required
Demonstrated proficiency with MS Office suites
Demonstrated skills in investigation, evaluation and negotiation
Strong knowledge of insurance theory and practices

Nice To Haves

2+ years of specific Worker's Compensation experience preferred
Ability to travel is required for some positions

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 fact, company standard and experience.
Occasionally claims adjusted by an Adjuster I 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 litigated claims. Gains trust of other parties to negotiations and demonstrates good sense of timing.
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 decision-making skills to gather, assess, analyze, question, verify, interpret and understand key or root issues.
Writes in a clear, succinct and fact-based 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 fast-paced environment.
Establishes and maintains effective relationships with customers and gains their respect and trust.
Performs other functional duties as requested or required.