The Workers' Compensation Managed Care Claims Assistant II has extensive knowledge of Workers’ Compensation Utilization Review, Case Management along with other Managed Care departments across multiple regions. Exhibits capabilities of learning additional tasks and responsibilities. The Managed Care Claims Assistant II will aid multiple Managed Care Departments by performing a variety of support services. The position has some oversight by the supervisor. The Claim Assistant II maintains a solid understanding of AmTrust’s mission, vision, and values. Upholds the standards of the AmTrust and Claims organization.

• Completes state forms and other jurisdictional requirements where applicable.
• Processes and assigns referrals and treatment requests across multiple states and jurisdictions following respective laws and regulations for the Clinical Review and Case Management Nurses.
• Ensures quality and timely service is provided for all requests and referrals.
• Uses critical thinking and decision-making skills to gather, assess, analyze, question, verify, and understand key or root issues and identify a solution.
• Acts as liaison with claims and clinical team to direct communication flow and document support level and services rendered.
• Provides support to other Managed Care teams as needed.
• Other administrative tasks or projects as assigned.
• Effectively interact with all levels of the organization.

• Knowledge of State and Federal Statues regarding Privacy and Confidentiality Laws
• Understanding State guidelines and URAC standards
• Ability to comfortably multi-task and pivot priorities as needed
• Understanding of Medical Terminology, ICDs, and CPT codes
• Ability to take direction, think critically, and make decisions
• Detail oriented and self-motivated
• Highly organized
• Ability to learn new procedures quickly and adapt to a changing environment
• Professional telephone demeanor and proficient in verbal and written communication
• Ability to work well under pressure and in a fast-paced environment
• Knowledge of business technology, MS Office, and Digital Healthcare Platforms
• Ability to work independently and in a team environment

EDUCATION/EXPERIENCE:

• High school diploma
• Some college preferred
• 2+ years of experience in a worker's compensation case management department or related experience

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.

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.