Claims Examiner, Medical Only

AmTrust Financial Services, Inc.•South Jordan, UT

3d•$22 - $27

About The Position

The Worker’s Compensation Medical Only Claims Adjuster is responsible for the prompt and effective investigation of worker’s compensation claims involving injuries that require medical treatment but no wage loss. Claim adjudication requires interaction with Insureds, claimants, medical providers and other parties to ensure adequate medical treatment is provided while utilizing Company resources in a cost-effective manner.

Requirements

Proficiency with MS Word, Excel and other business applications
Demonstrated skills in critical thinking and independent decision making
State licensing requirements (if applicable)

Nice To Haves

Minimum of 2 years handling Medical Only or other Workers Compensation Claims experience
Basic knowledge of medical conditions, treatment plans and casual relation to occupational injury/illness

Responsibilities

Ability to multitask and prioritize work in a fast-paced environment and manage time effectively
Investigates losses of low to moderate severity to determine cause, scope and extent of injury and/or liability for potential subrogation
Verifies coverage and confirms policy conditions have been met
Obtains missing information and ensures data integrity for Regulatory reporting
Communicates effectively with claimants, policyholders, Underwriters, agents, and other internal and external stakeholders
Authorizes medical treatment and schedules medical appointments.
Establishes medical reserves, approves medical bills and reviews/requests medical records
Documents all correspondence, reports, discussions and decisions in Claim file notes
Knowledge of multiple state jurisdictions (if applicable)
Obtain appropriate Adjuster licensing (If applicable)
Performs other related duties as assigned