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Complex Worker's Compensation Adjuster

AmTrust Financial
life insurance, paid time off, 401(k)
United States, Texas, Dallas
Feb 12, 2025

Complex Worker's Compensation Adjuster
Job Locations

US-United States


Requisition ID
2024-17841

Category
Claims - Workers Compensation

Position Type
Regular Full-Time



Overview

AmTrust Financial Services, a fast growing commercial insurance company, is seeking a Complex Workers' Compensation Claims Adjuster. The successful candidate will directly handle the most complex claims to including Workers Compensation related claims. The successful candidate will evaluate coverage issues and risk transfer opportunities as well as ensuring appropriate investigation of the underlying facts and circumstances is carried out, proper experts are retained and utilized where necessary, selection and utilization of counsel is appropriate, and proper negotiation strategy is employed. This position reports to a line of business executive. We are hiring claims adjusters to support complex handling in multiple zones (Western, Central, and Eastern).



Responsibilities

Responsibilities:
1.Thorough understanding of laws, principles of coverage, liability and insurance industry in general.
2.Analytical and human relations skills are critical.
3.Leadership skills; ability to plan, organize, delegate and develop corporate human resources.
4.Effective communication skills; ability to obtain information from others and deliver information to others orally and in written form.
5.Ability to carry out detailed written and verbal instructions.
6.Ability to work with little supervision and direction.
7.Sound command of the English language.
8.Ability to operate business technology.
9.Oversees the handling of all aspects of the claims assigned to the unit including reserving, communication, documentation, litigation management, evaluation, negotiation and settlement.
10.Ensures all claims eligible or ineligible for payment conform to quality, production standards and specifications.
11.Ensures claim processing is consistent with applicable policies, procedures and department guidelines.
12.Supervises maintenance of all claim records.
13.Reviews appeals and complaints and prepares formal response to consumer complaints.
14.Analyzes and approves insurance claim payment.
15.College degree or 10 years equivalent experience and skills required.
16.Valid adjuster's license in appropriate jurisdictions or ability to obtain such, if required by subordinate position duties.
17.Investigates coverage, including review of policy and underlying claim facts. Evaluates coverage issues and risk transfer opportunities
18.Evaluate and provide guidance on coverage and compensability issues, investigation, proactive medical and disability management, utilization of vendors and experts, litigation management, exposure mitigation and optimal claim resolution
19.Evaluates exposures to establish and maintain appropriate reserves
20.Leverages strong critical thinking and decision-making skills to gather, assess, analyze, question, interpret and understand key or root claim issues
21.Provide authority and direction on claim settlement
22.Effectively communicate exposures both internally and externally
23.Establish and maintain effective relationships, gaining respect and trust of internal and external stakeholders
24.Perform Claim Audits
25.Position may require periodic travel to attend meditations, trials and / or other related meetings
26.Writes in a clear, succinct, and fact-based manner
27.Keeps current with market trends and demands.
28.Performs other functionally related duties as assigned.

Qualifications:
Required:

*Proficient computer skills required to navigate our paperless claim file system
*Possesses a high level of technical claim and legal knowledge and skills
*Excellent communication skills both written and verbal
*Ability to professionally interact at a high level with parties both internal and external to AmTrust
*Easily adapts to changing situations requirements or priorities
*Ability to effectively influence others without damaging relationships
*Skillful negotiator

Preferred:
*Proficient in Microsoft Word, Excel and PowerPoint
*Proficient in California workers' compensation
*CPCU designation/AIC certification

This job description is designed to provide a general overview of the requirements of the job and does not entail a comprehensive listing of all activities, duties, or responsibilities that will be required in this position.


Qualifications

    Minimum of 7+ years' experience in the handling or litigating of complex workers compensation claims.
  • Proficient computer skills required to navigate our paperless claim file system.
  • Possesses a high level of technical claim and legal knowledge and skills.
  • Excellent communication skills both written and oral.
  • Ability to professionally interact at a high level with parties both internal and external to AmTrust.
  • Easily adapts to changing situations requirements or priorities.
  • Ability to effectively influence others without damaging relationships.
  • Skillful negotiator.
  • Home state adjuster license preferred.
  • Multi jurisdiction experience - California heavily preferred
  • CPCU designation/AIC certification preferred.


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.



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