Lead Claim Examiner , CA

Overview

Responsible for the prompt and efficient examination, investigation and settlement or declination of insurance claims through effective research, negotiation and interaction with insureds and claimants, ensuring that company resources are utilized in a cost effective manner in the process.

Those within a 50-mile radius of an AmTrust office will be expected to abide by a hybrid schedule.

• 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.

• 2+ years experience as a Workers Comp adjuster handling California claims
• Must be current on Continued Education Units
• MS Office experience (Word, Excel, Outlook)
• Effective negotiation skills
• Strong verbal and written communication skills
• Ability to prioritize work load to meet deadlines