Claims Adjuster II
US-TX-Dallas
careers
Req #: 18689
Type: Regular Full-Time
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Overview: The experienced Workers Compensation Lost Time Adjuster is responsible responsible for the prompt and efficient investigation of a reported workplace incident, accident or injury. The adjuster will handle the investigation and benefit management in claims of increasing complexity based on the experience level. The adjuster is responsible for engaging appropriate parties to effectively manage the claim through resolution, ensuring that company resources are utilized 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. Sign on bonus available! Responsibilities: * Analyzes coverage to ensure incident/accident and appropriate parties are covered by the claim policy. Reviews coverage issues with supervisor as needed. * Investigates claims by making quality, timely and appropriate contact with involved or interested parties including but not limited to the insured or employer representatives, claimant, witnesses, producers and Amtrust colleagues. * Obtains information and performs data management with attention to detail and accuracy to support to achieve timely submission of EDI and state regulatory filing requirements. * Obtain, review, evaluate and document, medical records and reports, police, ambulance, agency reports, photographs or other documents relevant to claim management * Demonstrates ability to learn technical materials, leverages and builds critical thinking and decision-making skills to support quality action plans for effective and efficient claim management * Establishes reserves based on estimating most probable outcome of a claim based on the facts for the case and company standard. Adjust reserves based on facts, company standard and experience. * Communicates timely and effectively with stakeholders, including but not limited to the insured or employer representatives, claimant, witnesses, producers and Amtrust colleagues. * Build strong relationships, applying company principles and standards on matters with assigned legal counsel * Effectively evaluate and negotiate potential resolutions for litigated and non-litigated claims * Manages time and diary/task system effectively and efficiently. Ability to multi-task and prioritize work in a fast paced environment, maintaining quality and meeting deadlines. * Writes in a clear, succinct and fact-based manner in Claims files as well as in other communication. * Establishes and maintains effective relationships with internal and external business partners and customers, gaining their respect and trust * Seeks, receives and provides feedback and constructive criticism for continual learning and growth in the role * Performs other functional duties as requested or required. #LI-GH1 #LI-HYBRID Qualifications: * Bachelor's degree or equivalent experience * License in TX or OK required * 3+ years claims handling experience - Worker's Compensation specific * 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 - travel
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