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Claims Resolution Specialist

2 months ago

Dallas, Texas, United States AmTrust Financial Full time
Job Summary

We are seeking a highly skilled Claims Resolution Specialist to join our team at AmTrust Financial. As a Claims Resolution Specialist, you will be responsible for the prompt and independent review of insurance claims, through effective research, evaluation, investigation, negotiation, and interaction with insureds, claimants, and counsel.

Key Responsibilities
  • Investigate claims or coverage by making timely and appropriate contact with involved or interested parties, including insureds, claimants, witnesses, and producers.
  • Analyze coverage that may or may not be applicable to the claim by policy or statutes, and review coverage issues as needed, drafting positions as required.
  • Establish reserves based on estimating the most likely outcome of a claim, based on facts, company standards, and experience.
  • Negotiate litigated and non-litigated claims, gaining trust with other parties and demonstrating good timing.
  • Communicate with internal Managed Care and Medical resources to ensure coordination with Medical providers on the development and authorization of appropriate treatment plans and accurate billing.
  • Obtain medical records and reports, police, ambulance, and agency reports, photographs, and measurements.
  • Leverage critical thinking and decision-making skills to gather, assess, analyze, question, verify, interpret, and understand key or root issues.
  • Write in a clear, succinct, and fact-based manner in Claims files and other communication.
  • Demonstrate ability to learn technical materials and learn from mistakes.
  • Manage time and diary entries effectively and efficiently, prioritizing work in a fast-paced environment.
  • Establish and maintain effective relationships with customers and gain their respect and trust.
Requirements
  • Bachelor's degree or equivalent experience.
  • 3+ years of claims handling experience.
  • Preferred experience handling litigated or complex claims.
  • 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.
What We Offer

AmTrust Financial Services offers a competitive compensation package and excellent career advancement opportunities. Our benefits include medical and dental plans, life insurance, health care flexible spending, dependent care, 401k savings plans, and 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 human differences with regard to race, ethnicity, gender, sexual orientation, culture, religion, or disabilities.