Claims Adjuster II, CA

Company: AmTrust Financial Services, Inc.
Location: Fresno
Posted on: May 21, 2023

Job Description:

Overview:Works independently to manage worker' compensation cases, including complex and catastrophic claims.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 contactsEnsure the privacy and security of Protected Health Information (PHI)Analyze claim, investigate and estimate proper reservesDevelop and maintain relevant plan of actionSet up and maintain timely benefit payments (Includes wage statement calculation and diary management)Identification and pursuit of subrogationTimely review and maintenance of incoming mailTimely response to Request for Authorization or referral for Utilization ReviewConsistent 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 adequacyTimely evaluation of reserve adequacyProactively maintaining current status of claimsIdentify, rate and reserve for possible permanent disabilityEvaluate claim for settlement purposesTimely excess Carrier ReportingClose cases in a timely and expedient mannerOther duties as may be assignedMust be able to work at least 40 hours per week, Monday thru Friday and be available to work extended hours as situations arise.Qualifications:Any combination equivalent High School graduation and/or two year community college or experience in business or closely related field. Requires minimum of 3 or more years of workers' compensation experience. 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.Self-Insurance Certificate, WCCA and/or WCCP preferred. Must be Current on Worker's Compensation education training hours. PHYSICAL DEMANDSThe physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.While performing the duties of this job, the employee is regularly required to sit, talk and hear. The employee frequently is required to use hands to operate a computer keyboard, handle, or feel and reach with hands and arms. The employee is occasionally required to stand and walk. The employee must occasionally lift and/or move up to 10 pounds. Specific vision abilities required by this job include close vision, distance vision, color vision, peripheral vision, depth perception, and ability to adjust focus.WORK ENVIRONMENTThe work environment characteristics described here are representative of those an employee encounters while performing the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. While performing the duties of this job, the employee is occasionally exposed to outside weather conditions. The noise level in the work environment is usually quiet to low.The salary range for this role is $31.00/hr. - $39.91/hr 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.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.

Keywords: AmTrust Financial Services, Inc., Fresno , Claims Adjuster II, CA, Other , Fresno, California