Senior Claim Examiner
AmTrust Financial Services, Inc., Salt Lake City, UT, United States
Overview
AmTrust is seeking experienced claims professionals from any line of claims who bring claim management and/or leadership experience and are eager to take the next step in their career. This role will join our Workers’ Compensation Claims team as a Senior Claim Examiner, with a clear opportunity to grow into a people leadership or management position. The primary focus of this role is the independent review, negotiation, and resolution of claims in a timely and cost-effective manner. While prior Workers’ Compensation experience is preferred, we are open to candidates from other claim disciplines and are willing to provide training on Workers’ Compensation for the right individual.
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 a timely and accurate reserve based on facts, company standards and experience.
Establishes an effective litigation plan and builds relationships with internal or panel counsel. Applies company principles and standards including planning, organizing and monitoring legal panel services and costs 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 an optimal outcome. Gains the trust of other parties to negotiations and demonstrates good timing, approaching discussions from the merits or strengths of the 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, provide insights and input when reviewing claims of others. May be sought out by others for advice.
Write in a clear, succinct and fact‑based manner in claims files as well as in other communications.
Demonstrate timeliness in managing the diary ensuring fact‑based and up‑to‑date entries.
Establish and maintain effective relationships with customers, gaining their respect and trust.
May serve as Acting Supervisor when 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.
Required Qualifications
Bachelor’s degree or equivalent experience
5+ years claims handling experience
State licensure as required
Proficiency with MS Office suites
Investigation, evaluation and negotiation skills
Strong knowledge of insurance theory and practices
Required to travel for some positions
Preferred Qualifications
Multi‑jurisdictional experience
Prior leadership/supervisory experience
CPCU designation, AIC, ARM, or other claims certification preferred.
What We Offer AmTrust Financial Services offers a competitive compensation package and excellent career advancement opportunities. Our benefits include: Medical & Dental Plans, Life Insurance (including eligible spouses & children), Health Care Flexible Spending, Dependent Care, 401(k) Savings Plans, and Paid Time Off. AmTrust strives to create a diverse and inclusive culture where the thoughts and ideas of all employees are appreciated and respected. This concept encompasses but is not limited to human differences with regard to race, ethnicity, gender, sexual orientation, culture, religion or disabilities. AmTrust values excellence and recognizes that by embracing the diverse backgrounds, skills, and perspectives of its workforce it will sustain a competitive advantage and remain an employer of choice. Diversity is a business imperative, enabling us to attract, retain and develop the best talent available. We see diversity as more than just policies and practices – it is an integral part of who we are as a company, how we operate and how we see our future.
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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 a timely and accurate reserve based on facts, company standards and experience.
Establishes an effective litigation plan and builds relationships with internal or panel counsel. Applies company principles and standards including planning, organizing and monitoring legal panel services and costs 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 an optimal outcome. Gains the trust of other parties to negotiations and demonstrates good timing, approaching discussions from the merits or strengths of the 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, provide insights and input when reviewing claims of others. May be sought out by others for advice.
Write in a clear, succinct and fact‑based manner in claims files as well as in other communications.
Demonstrate timeliness in managing the diary ensuring fact‑based and up‑to‑date entries.
Establish and maintain effective relationships with customers, gaining their respect and trust.
May serve as Acting Supervisor when 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.
Required Qualifications
Bachelor’s degree or equivalent experience
5+ years claims handling experience
State licensure as required
Proficiency with MS Office suites
Investigation, evaluation and negotiation skills
Strong knowledge of insurance theory and practices
Required to travel for some positions
Preferred Qualifications
Multi‑jurisdictional experience
Prior leadership/supervisory experience
CPCU designation, AIC, ARM, or other claims certification preferred.
What We Offer AmTrust Financial Services offers a competitive compensation package and excellent career advancement opportunities. Our benefits include: Medical & Dental Plans, Life Insurance (including eligible spouses & children), Health Care Flexible Spending, Dependent Care, 401(k) Savings Plans, and Paid Time Off. AmTrust strives to create a diverse and inclusive culture where the thoughts and ideas of all employees are appreciated and respected. This concept encompasses but is not limited to human differences with regard to race, ethnicity, gender, sexual orientation, culture, religion or disabilities. AmTrust values excellence and recognizes that by embracing the diverse backgrounds, skills, and perspectives of its workforce it will sustain a competitive advantage and remain an employer of choice. Diversity is a business imperative, enabling us to attract, retain and develop the best talent available. We see diversity as more than just policies and practices – it is an integral part of who we are as a company, how we operate and how we see our future.
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