Resolution Claims Adjuster III

About the position

The Resolution Claims Adjuster III position is a remote opportunity for individuals located 50 miles or more from an AmTrust office, while those within a 50-mile radius are expected to follow a hybrid work schedule of three days on-site and two days working from home. This role is crucial in the prompt and independent review of insurance claims, requiring effective research, evaluation, investigation, negotiation, and interaction with insureds, claimants, and legal counsel. The Adjuster will handle mid-sized and mid-complexity claims, ensuring a solid understanding of AmTrust's mission, vision, and values, while upholding the standards of the AmTrust Claims organization. In this role, the Adjuster will be responsible for investigating claims by making timely and appropriate contact with involved parties, analyzing coverage applicability, establishing and adjusting reserves based on case facts, and negotiating both litigated and non-litigated claims. The position requires strong communication skills, both written and oral, and the ability to build effective relationships with customers and internal stakeholders. The Adjuster will also be expected to manage time efficiently in a fast-paced environment and perform other functional duties as required. Unique responsibilities include completing basic compensability analysis, verifying the nature and extent of injuries, identifying changes in claim exposure, and demonstrating a high level of technical claim and legal knowledge. The Adjuster must possess excellent negotiation skills and the ability to influence others positively without damaging relationships. This position is essential for maintaining the integrity and efficiency of the claims process at AmTrust.

Responsibilities
• Investigates the claim or coverage by making timely and appropriate contact with involved or interested parties including but not limited to the insured or employer representatives, claimant or injured workers, witnesses and producers.
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• Analyzes coverage that may or may not be applicable to the claim by policy or statutes. Reviews coverage issues as needed and drafts positions as required.
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• Establishes reserves based on estimating most likely outcome of a claim based on the facts for the case and company standard. Adjust reserves based on facts, company standard and experience.
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• Occasionally claims adjusted by an Adjuster II / III will involve working with internal or assigned Legal Counsel. Build strong relationships, applying company principles and standards in partnership with internal legal counsel.
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• Effectively negotiates litigated & non-litigated claims. Gains trust of other parties to negotiations and demonstrates good sense of timing.
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• 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.
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• Obtain medical records and reports, police, ambulance and agency reports; photographs and measurements.
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• Leverages and builds critical thinking and decision-making skills to gather, assess, analyze, question, verify, interpret and understand key or root issues.
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• Writes in a clear, succinct and fact-based manner in Claims files as well as in other communication.
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• Demonstrates ability to learn technical materials and learns from mistakes.
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• Manages time and diary entries effective and efficiently, prioritizing work in a fast-paced environment.
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• Establishes and maintains effective relationships with customers and gains their respect and trust.
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• Performs other functional duties as requested or required.

Requirements
• Bachelor's degree or equivalent experience
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• 3+ years claims handling experience
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• Preferred experience handling litigated or complex claims
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• State licensure as required
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• Demonstrated proficiency with MS Office suites
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• Demonstrated skills in investigation, evaluation and negotiation
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• Strong knowledge of insurance theory and practices
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• Ability to travel is required for some positions.

Nice-to-haves
• Multijurisdictional experience may be required
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• CPCU, ARM, AIC or other claims certifications

Benefits
• Medical & Dental Plans
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• Life Insurance, including eligible spouses & children
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• Health Care Flexible Spending
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• Dependent Care
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• 401k Savings Plans
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• Paid Time Off

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