Lead Claim Examiner I

AmTrust Financial Services, Inc.•Boca Raton, FL

9d•Hybrid

About The Position

The Workers’ Compensation Examiner Lead is responsible for promptly and efficiently investigating, evaluating, and settling or declining insurance claims through research, negotiation, and interaction with insureds, claimants, and medical providers. The Lead Examiner is often, though not always, assigned larger or more complex claims than an Adjuster I or II. The role requires maintaining an understanding of AmTrust’s mission, vision, and values and upholding the standards of AmTrust and the Claims organization. This position is based out of the Boca office and follows a hybrid arrangement, with four days in the office.

Requirements

Bachelor’s degree or equivalent experience.
At least 3 years of workers’ compensation claims handling experience.
Demonstrated proficiency with Microsoft Office suites.
Demonstrated skills in investigation, evaluation, and negotiation.
Strong knowledge of insurance theory and practices.

Responsibilities

Follow AmTrust policies and procedures in managing claims.
Investigate claims and coverage by making timely, appropriate contact with involved or interested parties, including insureds, claimants, witnesses, and medical providers.
Evaluate, establish, maintain, and adjust reserves based on facts, company standards, and experience.
Negotiate claims effectively, build trust with other parties, and pursue timely resolutions based on the merits or strengths of each case.
Use critical thinking and decision-making skills to gather, assess, analyze, question, verify, interpret, and understand key or root issues.
Establish effective relationships with internal or assigned counsel and develop customized defense plans.
Apply company principles and standards to plan, organize, and monitor legal panel services and costs in partnership with internal legal counsel.
Coordinate with internal managed care and medical resources, medical providers, injured workers, and employers to develop return-to-work strategies and treatment plans.
Obtain past and present medical records and other required reports, including police, ambulance, and agency reports.
Provide insights and input when reviewing others’ claims and offer advice when sought.
Write clearly, succinctly, and factually in claims files and other communications.
Manage mail and diary entries effectively and efficiently.
Provide exceptional customer service.
Perform other functional duties as requested or required.