Claims Examiner

Overview

The Workers’ Compensation Claims Examiner, Medical Only team, plays a vital role in swiftly and efficiently investigating workers’ compensation claims for injuries that need medical care, but don't involve lost wages. This dynamic position involves engaging with employers, claimants, medical providers, and other stakeholders to guarantee top-notch medical treatment is delivered using company resources in a smart and cost-effective way.

AmTrust is a leading entity in the commercial property and casualty sector, ranking as the third largest provider of workers' compensation in the United States. Our portfolio of small business insurance products is continually growing, and we are seeking motivated individuals to become part of our dynamic team.

Note, this role works on a hybrid schedule out of our Maitland, FL office location

Responsibilities

• Thrive in a fast-paced setting by juggling multiple tasks and prioritizing effectively.
• Dive into investigating losses ranging from low to moderate severity, pinpointing the cause, scope, and extent of injury or liability for potential subrogation.
• Confirm coverage and ensure all policy conditions are met.
• Gather missing information and guarantee data integrity for seamless regulatory reporting.
• Communicate effectively with claimants, policyholders, underwriters, agents, and other vital internal and external partners.
• Approve medical treatment and seamlessly schedule appointments.
• Set medical reserves, review and approve medical bills, and diligently review/request medical records.
• Keep meticulous claim file notes documenting every correspondence, report, discussion, and decision.
• Knowledge of multi-state jurisdictions (if applicable)
• Ability to obtain appropriate examiner licensing (if applicable)

Qualifications

Required

• Proficiency with MS Word, Excel, and other business applications
• Demonstrated skills in critical thinking and independent decision making
• State licensing requirements (if applicable)

Preferred:

• 2 years handling Medical Only or other Workers’ Compensation claims experience preferred but not required.
• Prior customer service, client support, and/or user assistance experience is a plus
• Basic knowledge of medical conditions, treatment plans and casual relation to occupational injury/illness or ability to learn them
• Drive and desire to use this position as a starting point to potentially enter the Claim Associate training program and become a Lost Time adjuster in the future

Benefits

• 20 Paid Holidays and 18 days of PTO
• Monday through Friday work schedule – no nights or weekends required
• 401k Savings Plan
• Medical, Dental and Vision Health Benefits – including spouses and children
• Internal Wellness Program with yearly discounts and incentives