Manage complex workers’ compensation claims from investigation through resolution. Responsibilities include determining compensability, setting reserves, reviewing medical bills, authorizing treatment, processing payments, negotiating settlements, communicating with claimants and providers, ensuring regulatory compliance, and coordinating with attorneys on litigation and claim strategy. The role also supports junior examiners through mentoring and requires strong technical claims knowledge, communication, negotiation, organization, and multitasking skills.
Overview
Responsibilities
Qualifications
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.
Senior Claim Examiner
- 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.
- Requires 5+ years of workers’ compensation claims experience and strong technical knowledge.
Lead Claim Examiner
- Responsible for prompt and efficient investigation, evaluation and settlement or declination of insurance claims through effective research, negotiation and interaction with insureds, claimants and medical providers.
- Maintains a solid understanding of AmTrust’s mission, vision, and values. Upholds the standards of AmTrust and the Claims organization.
- Requires 3+ years of workers’ compensation claims experience and 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.
Qualifications
- Requires 5+ years of workers’ compensation claims experience and 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
AmTrust Financial Chicago, Illinois, USA Office
Chicago, United States, 0
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