Senior Claim Examiner I, OK

AmTrust Financial Services, Inc. • Overland Park, KS

9d

About The Position

The Senior Claim Examiner manages complex and high-exposure workers’ compensation claims from start to resolution. The role involves investigating claims, determining compensability, setting reserves, negotiating settlements, and ensuring compliance with applicable state regulations. The examiner also serves as a resource for junior examiners and assists with mentoring.

Requirements

• At least 5 years of workers’ compensation claims experience.
• Strong technical knowledge of workers’ compensation claims.
• Experience with Microsoft Office, including Word, Excel, and Outlook.
• Effective negotiation skills.
• Strong verbal and written communication skills.
• Ability to prioritize workload to meet deadlines.
• Ability to manage multiple tasks in a fast-paced environment.

Responsibilities

• Investigate workers’ compensation claims by contacting injured workers, medical providers, and employer representatives.
• Determine whether claims are valid under applicable workers’ compensation statutes.
• Communicate with medical providers to develop and authorize appropriate treatment plans.
• Review and analyze medical bills to confirm that charges and treatment are related to the workers’ compensation injury and consistent with the treatment plan.
• Ensure medical bill and income-replacement payments are made promptly in accordance with applicable fee schedules and statutes.
• Answer questions from claimants, policyholders, and medical providers about pending claim status.
• Consult with attorneys regarding litigation management, settlement strategy, and claim resolution.
• Set reserves and negotiate settlements.
• Serve as a resource for junior examiners and assist with mentoring.

What This Job Offers

• Job Type: Full-time
• Career Level: Senior
• Education Level: No Education Listed