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Company

AmTrust Financial Services, Inc. · 4 hours ago

Claims Adjuster III, Workers Compensation

United States

Full-time

Remote

Mid Level

$83K/yr - $102K/yr

3+ years exp

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Responsibilities

Set up claims and make timely three point contacts

Ensure the privacy and security of Protected Health Information (PHI)

Analyze claim, investigate and estimate proper reserves

Develop and maintain relevant plan of action

Set up and maintain timely benefit payments (Includes wage statement calculation and diary management)

Identification and pursuit of subrogation

Timely review and maintenance of incoming mail

Timely response to Request for Authorization or referral for Utilization Review

Consistent communication and claim reviews with all parties, including our Claims Services Account Manager in relation to brokers and policy holders.

The agricultural accounts are generally higher volume policies, fast-paced and seasonal, and special handling is oftentimes required.

Timely evaluation of reserve adequacy

Proactively maintaining current status of claims

Identify, rate and reserve for possible permanent disability

Evaluate claim for settlement purposes

Timely excess Carrier Reporting

Close cases in a timely and expedient manner

Other duties as may be assigned

Must be able to work at least 40 hours per week, Monday thru Friday and be available to work extended hours as situations arise.

Qualification

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Workers' Compensation experienceLitigated claims experienceNon-litigated claims experienceClaims administration knowledgeSelf-Insurance regulations knowledgeCurrent on Worker’s Compensation educationAnalyze reportsWrite reportsInterpret technical instructionsTime management skills

Required

3 to 5 years of commercial Workers’ Compensation experience

Any combination equivalent High School graduation and/or two year community college or experience in business or closely related field

Litigated and non-litigated claims experience required

Basic mathematical skills required for calculations and ratings

Knowledge and understanding of workers’ compensation claims administration required

Through knowledge of Self-Insurance regulations, Case Law, Labor Code

Strong time management, organization and problem solving skills

Ability to read, analyze, and interpret common scientific and technical journals, financial reports, and legal documents

Ability to write letters, memos and reports that conform to prescribed style, format and grammatical correctness

Ability to effectively present information to top management

Extensive clear and tactful communications required via writing, reading, telephone calls, note taking, letter writing, memoranda, etc.

Must be able to negotiate

Ability to calculate figures and amounts such as discounts, interest, commissions, proportions, and percentages

Ability to define problems, collect data, establish facts, and draw valid conclusions

Ability to interpret an extensive variety of technical instructions in mathematical or diagram form and deal with several abstract and concrete variables

Must be Current on Worker’s Compensation education training hours