Senior Claims Examiner I

AmTrust Financial Services•Irvine, CA

7d•$44 - $54

About The Position

The Senior Claims Examiner I, CA is responsible for prompt efficient review and disposition of insurance claims through effective research, evaluation, investigation, negotiation and interaction with insureds or claimants. Maintains a solid understanding of AmTrust’s mission, vision, and values. Upholds the standards of the AmTrust and Claims organization.

Requirements

Bachelor’s degree or equivalent experience
5+ years claims handling experience
State licensure as required
Demonstrated proficiency with MS Office suites
Demonstrated skills in investigation, evaluation and negotiation
Strong knowledge of insurance theory and practices
Ability to travel is required for some positions

Nice To Haves

Multijurisdictional experience
CPCU designation, AIC, ARM, or other claims certification preferred.

Responsibilities

Investigates the claim or coverage by making timely and appropriate contact with involved or interested parties including but not limited to the insured or employer representatives, claimants or injured workers, witnesses and producers.
Determines, reviews and analyzes coverage.
While operating autonomously, elevates coverage issues as needed with appropriate resources and drafts positions as required.
Responsible for setting of timely and accurate reserves based on facts, company standard and experience.
Establishes effective litigation plan and build relationship with internal or panel counsel.
Applies company principles and standards including planning, organizing and monitoring legal panel services and cost in partnership with internal legal counsel.
Leverages strong critical thinking and decision-making skills to gather, assess, analyze, question, verify, interpret and understand key or root issues.
Skillfully negotiates claims after gaining effective leverage points to effectuate optimal outcome.
Gains trust of other parties to negotiations and demonstrates good sense of timing.
Approaches discussions from merits or strengths of case.
Depending on the type of claim may: Communicate with internal Managed Care and Medical resources to ensure coordination with Medical providers on the development and authorization of appropriate treatment plans as well as accurate billing.
Obtain medical records and reports, police, ambulance and agency reports; photographs and measurements.
As part of a team, provides insights and input when reviewing claims of others.
May be sought out by others for advice.
Writes in a clear, succinct and fact-based manner in Claims files as well as in other communication.
Demonstrates timeliness in managing the diary ensuring fact based and up to date entries.
Establishes and maintains effective relationships with customers and gains their respect and trust.
May serve as Acting Supervisor as requested; may mentor Adjusters with less experience.
May be required to work overtime as assigned.
Keeps current with market trends and demands.
Performs other functionally related duties as assigned.