Claims adjuster III

Overview

Works independently to manage Workers' Compensation cases, including complex and catastrophic claims.

Note commercial Workers' Compensation experience in California is required.

Responsibilities

DISTINGUISHING CHARACTERISTICS:

Administers complex non-litigated and litigated workers’ compensation cases and integrates the delivery of benefits associated with sickness and long-term disability benefits.  Provides technical guidance, mentoring and support to claims assistants and clerical staff.

ESSENTIAL DUTIES AND RESPONSIBILITIES:

To perform this job successfully, the employee must be able to efficiently and effectively perform each of the following essential functions.  Reasonable accommodation may be made for individuals with disabilities.

The functions of this job include but are not limited to;           

• 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.

Qualifications

Qualifications:

• Requires 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.
• Must possess 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.

Your employer reserves the right to modify the description of the duties and the requirements of this job at any time upon reasonable notice.

The salary range for this role is $83k- $102k. This range is only applicable for jobs to be performed in California. Base pay offered may vary depending on, but not limited to education, experience, skills, geographic location, travel requirements, sales or revenue-based metrics. This range may be modified in the future.

Your employer reserves the right to modify the description of the duties and the requirements of this job at any time upon reasonable notice.

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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.