Medical Claims Specialist

2 days ago


Hamilton, Waikato, New Zealand Amtrust Financial Services Inc. Full time

About Us
AmTrust Financial Services Inc. is a leading insurance carrier that provides workers compensation coverage to businesses across the United States. Our company is dedicated to delivering exceptional service and innovative solutions to our customers.

Job Summary
The Medical Only Claims Adjuster is responsible for handling claims involving medical treatment but no wage loss. This role requires strong communication and analytical skills, as well as the ability to multitask and prioritize work in a fast-paced environment.

Duties and Responsibilities
*Investigate losses of low to moderate severity to determine cause, scope and extent of injury and/or liability for potential subrogation
*Verify coverage and confirm policy conditions have been met
*Obtain missing information and ensure data integrity for regulatory reporting
*Communicate effectively with claimants, policyholders, underwriters, agents, and other internal and external stakeholders
*Authorize medical treatment and schedule medical appointments
*Establish medical reserves, approve medical bills, and review/request medical records
*Document all correspondence, reports, discussions, and decisions in the claim file notes

Requirements
*Proficiency with MS Word, Excel, and other business applications
*Demonstrated skills in critical thinking and independent decision-making
*State licensing requirements (if applicable)
*Basic knowledge of medical conditions, treatment plans, and causal relation to occupational injury/illness
*Minimum of 2 years handling Medical Only or other Workers' Compensation Claims experience
*Drive and desire to use this position as a starting point to potentially enter the Claim Associate training program and become a lost time adjuster in the future



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