Claims Examiner, Medical Only

AmTrust Financial Services•Maitland, FL

2d•Hybrid

About The Position

The Workers’ Compensation Medical Only Claims Examiner is responsible for the prompt and effective investigation of workers’ compensation claims involving injuries requiring medical treatment without lost wages. Claim adjudication requires interaction with employers, claimants, medical providers, and other parties to ensure adequate medical treatment is provided utilizing company resources in a cost-effective manner. Note, this is a hybrid opportunity out of our Maitland, FL office.

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
Drive and desire to use this position as a starting point to potentially enter the Claim Associate training program and become a lost time adjuster in the future

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 multi-state jurisdictions (if applicable)
Obtain appropriate examiner licensing (if applicable)
Performs other related duties as assigned