Senior Claim Examiner I

AmTrust Financial Services, Inc.•Princeton, NJ

About The Position

We are seeking experienced professionals to join our Workers’ Compensation team in two key roles: Senior Claim Examiner and Lead Claim Examiner. Both positions play 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, including investigation, determining compensability, setting reserves, and negotiating settlements. This role also involves serving as a resource for junior examiners and assisting with mentoring.

Requirements

5+ years of workers’ compensation claims experience
Strong technical knowledge
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

Responsibilities

Manage complex and high-exposure workers’ compensation claims from start to resolution.
Investigate claims, determine compensability, set reserves, and negotiate settlements.
Serve as a resource for junior examiners and assist with mentoring.
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.