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Title

Claims Examiner (Worker's Comp) 

About the Organization AmTrust Financial Services, Inc., (Nasdaq: AFSI) headquartered in New York City, is a multinational insurance holding company, which, through its insurance carriers, offers specialty property and casualty insurance products, including workers' compensation, commercial automobile and general liability; extended service and warranty coverage. For more information about AmTrust, visit www.amtrustgroup.com, or call AmTrust toll-free at 866.203.3037.  
Position Claims Adjuster III  
Location CA, San Francisco  
Description

 

Job Summary:

Responsible for managing an assigned number of Workers’ Compensation claims, ensuring adherence to government regulations, timely, accurate and cost-effective management and settlement of each case. May serve as department expert in training staff and management.

Job Duties:

Responsibilities included but are not limited to:

  • Provide superior customer service by returning a telephone calls and email correspondence within a timely manner and answering callers’ basic questions regarding claims.
  • Determine and resolve issues of coverage, compensability and liability, in order to delay, accept or deny claims within the statutory time constraints.
  • Administer benefits of temporary disability, permanent disability, vocation rehabilitation and medical treatment in compliance with the CA State Workers’ Compensation Laws, Federal Laws and company guidelines
  • Prepare claims defense to mitigate liability by effectively using defense medical evaluations, QMEs, AMEs, investigations, depositions, and to pursue subrogation where applicable
  • Review all files on a 30 day diary, addressing reserves, mail, issue identification, strategy development, follow-up and aggressive action.
  • Participate in negotiation process by attending hearings and providing deposition and testimony to ensure cost effective resolution of each case
  • Interact and effectively communicate via telephone, electronic, and written correspondence with claimants, attorneys, doctors, counselors, investigators, agents, and insureds.
  • Interact and effectively communicate and work with team members, Supervisors, Management and others, demonstrating professional courtesy at all times
  • Continue training and development (seminars, classes) to keep abreast of changing laws and procedures and to enhance file handling techniques.
  • Maintain certification and licensing as required by CA law
  • Serve as the liaison between the company and the insured, and conduct regular claims reviews with the insured and broker
  • Advise Examiners and Assistants on technical questions

 

 
Position Requirements

 

  • Bachelor’s degree or equivalent in work experience
  • At least 2+ years experience as a Workers Comp claims examiner, level I and II
  • 3+ years experience for Senior level examiner
  • SIP certificate or obtained within one year required
  • Full knowledge of related government laws and regulations
  • General computer knowledge and experience with Microsoft Office Suite (Word, Excel, Access, Powerpoint)
  • Ability to analyze and organize information
  • Exceptional time management skills
  • Strong verbal and written communication skills
  • Ability to supervise, coach, and lead team of Examiners and Assistants when necessary

 

 
Open Date 2/1/2013  
Full-Time/Part-Time Full-Time  
Req Number CLA-13-00010  
Shift -not applicable-  
Number of Openings 1  

This position is currently not accepting applications.

To search for an open position, please go to http://AmTrustNorthAmerica.appone.com



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