Senior Claim Examiner I

AmTrust Financial Services • Dallas, TX

8d

About The Position

We are seeking experienced professionals to join our Workers’ Compensation team as a Senior Claim Examiner. This position plays a critical role in managing workers compensation claim files and ensuring compliance with state regulations while delivering exceptional service. The Senior Claim Examiner will manage complex and high-exposure workers’ compensation claims from start to resolution. This includes investigating claims, determining compensability, setting reserves, and negotiating settlements. The role also involves serving as a resource for junior examiners and assisting with mentoring. A minimum of 5+ years of workers’ compensation claims experience and strong technical knowledge are required.

Requirements

• MS Office experience (Work, Excel, Outlook)
• Effective negotiation skills
• Strong verbal and written communication skills
• Ability to prioritize work load to meet deadlines
• Ability to manage multiple tasks in a fast-paced environment
• 5+ years of workers’ compensation claims experience
• Strong technical knowledge

Responsibilities

• Thoroughly investigating workers’ compensation claims by contacting injured workers, medical providers, and employer representatives.
• Determining if claims are valid under applicable workers’ comp statutes.
• Communicating with medical providers to develop and authorize appropriate treatment plans.
• Reviewing and analyzing medical bills to confirm charges and treatment are workers’ comp injury-related and in accordance with the treatment plan.
• Ensuring payments for medical bills and income replacement are remitted on a timely basis in accordance with applicable fee schedules and statute.
• Answer questions regarding the status of pending claims from claimants, policyholders and medical providers.
• Consult with attorneys regarding litigation management, settlement strategy and claim resolution.

What This Job Offers

• Career Level: Senior
• Education Level: No Education Listed