Claims Examiner, Medical Only

AmTrust Financial

  • Dallas, TX
  • Permanent
  • Full-time
  • 9 days ago
Overview:The Worker’s Compensation Medical Only Claims Adjuster is responsible for the prompt and effective investigation of worker’s compensation claims involving injuries that require medical treatment but no wage loss. Claim adjudication requires interaction with Insureds, claimants, medical providers and other parties to ensure adequate medical treatment is provided while utilizing Company resources in a cost-effective manner. The adjuster will maintain a solid understanding of AmTrust’s mission, vision, and values and upholds the standards of the AmTrust and Claims organization. Responsibilities:1. Analyzes coverage to ensure incident/accident and appropriate parties are covered by the claim policy. Reviews coverage issues with supervisor as needed.2. Investigates medical only losses of low to moderate severity, by making timely contact(s) with appropriate parties.3. Obtains missing information and ensures data integrity for Regulatory reporting.4. Establishes medical reserves, obtains and reviews medical documentation to appropriately authorize and manage activites and validate relatedness of medical treatment.5. Review claims activity timely for ongoing management, closure or reassignment to a lost time adjuster.6. Documents all correspondence, reports, discussions and decisions in Claim system.7. Communicates timely and effectively with stakeholders, including but not limited to the insured or employer representatives, claimant, witnesses, producers and Amtrust colleagues. 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)
  • Ability to multitask and prioritize work in a fast-paced environment and manage time effectively
Preferred:
  • Minimum of 2 years handling Medical Only or other Workers Compensation Claims experience
  • Basic knowledge of medical conditions, treatment plans and casual relation to occupational injury/illness
  • 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.
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.

AmTrust Financial