Lead Claim Examiner I

Overview

The Workers' Compensation Examiner Lead is 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. The Lead Examiner  is often, though not always, assigned to larger or more complex claims than an Adjuster I or II. Maintains a solid understanding of AmTrust’s mission, vision, and values. Upholds the standards of AmTrust and the Claims organization. 

Responsibilities

• Follows AmTrust policies and procedures in managing claims.
• Investigates the claim and coverage by making timely and appropriate contact with involved or interested parties including but not limited to the insured, claimant, witnesses and medical providers.
• Evaluates, establishes, maintains, and adjusts reserves based on fact, company standard and experience.
• Skillfully negotiates claims, turning adverse perspectives into quick resolution. Gains trust of other parties to negotiations and demonstrates good sense of timing. Approaches discussions from merits or strengths of case.
• Leverages strong critical thinking and decision-making skills to gather, assess, analyze, question, verify, interpret and understand key or root issues.
• Establishes effective relationships with internal or assigned counsel for customized defense plan. Applies company principles and standards including planning, organizing and monitoring legal panel services and cost in partnership with internal legal counsel.
• Communicates with internal managed care and medical resources to ensure coordination with medical providers, injured workers and employers in developing return to work strategies and treatment plans.  
• Obtain medical records (past and present), police, ambulance and other agency reports as required.
• 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.
• Manages mail and diary entries effectively and efficiently.
• Provides exceptional customer service.
• Performs other functional duties as requested or required.

Qualifications

• Bachelor’s degree or equivalent experience
• 3+ years WC claims handling experience
• Demonstrated proficiency with MS Office suites
• Demonstrated skills in investigation, evaluation and negotiation
• Strong knowledge of insurance theory and practices