Presentation on theme: "Claims Management Program Overview"— Presentation transcript:
1 Claims Management Program Overview AmTrust North AmericaClaims Management Program Overview
2 Claim Office Locations AmTrust has 16 Claims Offices Countrywide, including 8 Regional Operations
3 AmTrust Claims Management Program AmTrust prides itself on handling claims expertly and expeditiously. We work closely with our insured’s and agent business partners to deliver high levels of customer service and maximum results.Key Features:Experienced staff assigned by claims type, licensed adjusters on staff in applicable states, average experience level is 21 years for workers’ compensation and 24 years for casualty claim staffState of the Art Windows based Claims Management SystemAppropriate adjuster claims workloads, enabling effective management of claimsAmTrust best practices used for claims work units, internal audit program to assure complianceNational In House Anti-Fraud, Subrogation, Salvage and Legal Bill Audit Units allow for strong focus on questionable claim investigation, claims $$ recovery and vendor cost controlNational relationships with Rx, Medical Provider and Investigative vendors expedite claims processing and mitigate claims costsQualified panel of defense attorneys who support our philosophy of aggressive and quality defense24/7 claims reporting via phone/fax/Self service Web Portal for access to claim information and loss run generation
4 AmTrust Claims Management Program Our claims management philosophy is grounded in conducting timely and detailed fact based investigations to determine liability/compensability, nature & extent of injury and potential financial exposure. All claims are carefully managed to bring them to timely disposition.Activities that support our philosophy:Initial 3 point contacts, 24 hours for employer/employee/doctor, 24 hours for insured and claimant contact on casualty claimsFact Investigation, recorded statements used to freeze facts and support ongoing investigation and claims management, on site investigation used when necessaryAmTrust best practices used by adjusters, audited by AmTrust claims managementAcute reserve and settlement awareness, timeframes and authority levels are closely controlled and set on individuals experience and technical skillsDefense attorneys closely monitored and follow AmTrust litigation management practicesStrong pursuit of subrogation and second injury fund relief when applicableInteraction with underwriting when trends or other claims issues detectedAutomatic system generated file diaries to adjuster and Supervisor for file update
5 AmTrust Claims Management Program Claims Operations – Where we go from here !Claims Operations Manager will assist with claims program setup, system access training and will remain in place for general troubleshootingClaims Welcome Kits will be sent at account inception containing first report instructions, statutory posting notices, managed care network panel if applicable, Rx program information and designated adjuster contact info.Key Contact Points:Claims Reporting: Toll Free (866) , Toll Free Fax (775) ,Claims Kit Inquiries/Issues including physician panel changes: Lisa Johnson, (888) x /Web Portal: Pre-registration is required.Specific claims inquiries: Contact applicable claims adjuster – see information on web portal or mailed acknowledgement for contact information.