Workers Compensation Claims Adjuster III, California

Workers Compensation Claim Adjuster III, CA is responsible for prompt efficient review and disposition of insurance claims through effective research, evaluation, investigation, negotiation and interaction with insureds or claimants. The Adjuster III is often, though not always, assigned to larger claims with a larger exposure or severity in the Line of Business. Maintains a solid understanding of AmTrust's mission, vision, and values. Upholds the standards of the AmTrust and Claims organization.

Leverages extensive experience and expertise to thoroughly investigate claims and coverage by engaging with various stakeholders such as insureds, employers, claimants, and witnesses.
• Determines, reviews and analyzes coverage. While operating autonomously, elevates coverage issues as needed with appropriate resources and drafts positions as required.
• Responsible for setting of timely and accurate reserves based on facts, company standard and experience.
• Establishes effective litigation plan and build relationship with internal or panel counsel. Applies company principles and standards including planning, organizing and monitoring legal panel services and cost in partnership with internal legal counsel.
• Leverages strong critical thinking and decision-making skills to gather, assess, analyze, question, verify, interpret and understand key or root issues.
• Demonstrates strategic negotiation skills by identifying leverage points, building trust with stakeholders, and advocating based on the merits of the case to achieve favorable outcomes.
• Depending on the type of claim may:
  1. Communicate with internal Managed Care and Medical resources to ensure coordination with Medical providers on the development and authorization of appropriate treatment plans as well as accurate billing.
  2. Obtain medical records and reports, police, ambulance and agency reports; photographs and measurements.
• As part of a team, provides insights and input when reviewing claims of others. May be sought out by others for advice.
• Writes in a clear, succinct and fact-based manner in Claims files as well as in other communication.
• Demonstrates timeliness in managing the diary ensuring fact based and up to date entries.
• Establishes and maintains effective relationships with customers and gains their respect and trust.
• May serve as Acting Supervisor as requested; may mentor Adjusters with less experience.
• May be required to work overtime as assigned.
• Keeps current with market trends and demands.
• Performs other functionally related duties as assigned.

Required:

• Bachelor's degree or equivalent experience
• Minimum of 5 years of specialized experience in workers' compensation claims handling
• State licensure as required
• Demonstrated proficiency with MS Office suites
• Demonstrated skills in investigation, evaluation and negotiation
• Strong knowledge of insurance theory and practices
• Flexibility to travel as needed based on the demands of the role

Preferred:

• CPCU designation, AIC, ARM, or other claims certification preferred.

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. AmTrust has the right to revise this job description at any time.

The salary range for this role is $33.64 an hour - $47.12 an hour. 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.

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.