Lead Claim Examiner I

AmTrust Financial Services•Princeton, NJ

About The Position

The Workers’ Compensation Examiner Lead is responsible for prompt and efficient investigation, evaluation, and settlement or declination of 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 a solid understanding of AmTrust’s mission, vision, and values and upholding the standards of AmTrust and the Claims organization.

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 through timely and 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 negotiating parties, use sound timing, and approach discussions based on the merits or strengths of the case.
Apply 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 to develop customized defense plans.
Apply company principles and standards when planning, organizing, and monitoring 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 medical records, including past and present records, and police, ambulance, and other agency reports as required.
Provide insights and input when reviewing other claims and offer advice to colleagues 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.