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Workers' Compensation Claims Adjuster III

3 months ago

Dallas, United States AmTrust Financial Full time

Overview:

Assigned to our Worker's Compensation Line of Business, the Adjuster III is responsible for prompt and independent review of insurance claims through effective research, evaluation, investigation, negotiation and interaction with insureds or claimants. The Adjuster III is often assigned to mid-size or mid complexity claims in the Line of Business. Maintains a solid understanding of AmTrusts mission, vision, and values. Upholds the standards of the AmTrust and Claims organization. Experience handling Worker's Compensation Claims is required for this position.

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, claimant or injured workers, witnesses and producers.
  • Analyzes coverage that may or may not be applicable to the claim by policy or statutes. Reviews coverage issues as needed with supervisor and drafts positions as required.
  • Establishes reserves based on estimating most likely outcome of a claim based on the facts for the case and company standard. Adjust reserves based on facts, company standard and experience.
  • Occasionally claims adjusted by an Adjuster II will involve working with internal or assigned Legal Counsel. Build strong relationships, applying company principles and standards in partnership with internal legal counsel.
  • Effectively negotiates non-litigated claims. Gains trust of other parties to negotiations and demonstrates good sense of timing.
  • 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.
  • Leverages and builds critical thinking and decision-making skills to gather, assess, analyze, question, verify, interpret and understand key or root issues.
  • Writes in a clear, succinct and fact-based manner in Claims files as well as in other communication.
  • Demonstrates ability to learn technical materials and learns from mistakes.
  • Manages time and diary entries effective and efficiently, prioritizing work in a fast-paced environment.
  • Establishes and maintains effective relationships with customers and gains their respect and trust.
  • Performs other functional duties as requested or required.
Qualifications:
  • Bachelors degree or equivalent experience
  • 3+ years claims handling experience - Worker's Compensation specific
  • State licensure as required
  • Demonstrated proficiency with MS Office suites
  • Demonstrated skills in investigation, evaluation and negotiation
  • Strong knowledge of insurance theory and practices
  • Ability to travel is required for some positions

Preferred:

  • Licensure in Texas, Louisiana, Oklahoma, Arizona


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, 401k Savings Plans, Paid Time Off.

AmTrust strives to create a diverse and inclusive culture where 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.