Senior Claim Examiner II, CA

AmTrust Financial Services•Irvine, CA

3d•$49 - $60

About The Position

AmTrust is actively seeking a skilled Resolution Examiner specializing in Workers' Compensation Claims. The primary focus will be on negotiating and settling claims efficiently and at a cost effective value. In this role, you will be entrusted with the independent review and resolution of workers' compensation claims; utilizing your expertise in negotiation and settlement strategies to bring claims to resolution posture. Your ability to effectively interact with insureds, claimants, and their legal representatives will be essential in driving timely settlements while adhering to AmTrust’s mission, vision, and values.

Requirements

Bachelor’s degree or equivalent experience.
Minimum of 3 years of experience in handling and settling workers' compensation claims.
State licensure as required.
Proficiency with MS Office Suite and claims management software.
Strong negotiation, investigation, and evaluation skills specific to workers' compensation claims.
In-depth knowledge of workers' compensation laws and insurance practices.
Ability to travel, as required for some positions.

Nice To Haves

Preferred experience in negotiating litigated or complex claims.
Multijurisdictional experience may be required.
CPCU, ARM, AIC, or other relevant claims certifications are preferred.

Responsibilities

Proactively negotiate settlements for workers' compensation claims, ensuring fair and expedient resolutions that meet the needs of all parties involved.
Conduct thorough investigations by engaging with insured representatives, claimants, and witnesses to gather critical information that supports settlement discussions.
Analyze coverage issues and the applicability of benefits under relevant policies and statutes to facilitate informed negotiation outcomes.
Establish and adjust reserves based on projected claim outcomes, ensuring alignment with corporate standards and settlement strategies.
Collaborate closely with internal Managed Care and Medical resources to ensure that treatment plans and billing are managed effectively during the settlement process.
Collect and evaluate essential documentation, including medical records and incident reports, to strengthen negotiation positions and expedite settlements.
Utilize critical thinking and decision-making skills to assess claims and develop effective negotiation tactics aimed at achieving optimal settlement outcomes.
Maintain clear, concise, and factual documentation in claims files and communications, supporting transparency throughout the settlement process.
Manage time effectively, prioritizing negotiations and settlements in a fast-paced environment to meet deadlines and client expectations.
Build and maintain strong relationships with customers, fostering their trust and confidence throughout the claims settlement process.
Conduct compensability analysis based on AOE/COE investigations to identify valid claims and streamline settlement negotiations.
Verify the nature and extent of injuries, adapting settlement strategies based on changes in claim exposure.
Leverage a high level of technical knowledge in workers' compensation claims to facilitate effective and timely settlements.
Exhibit exceptional communication skills, both written and oral, to professionally engage with all stakeholders involved in the claims process.
Adapt to changing circumstances and priorities, demonstrating flexibility in negotiations to achieve the best outcomes.