Advanced Workers' Comp Claim Specialist

AF Group; Atlanta (GA); À distance; USD 57 000 - 95 000; Plein temps

Résumé du poste

AF Group seeks a Claim Representative II to handle moderately difficult workers' compensation claims, verify coverage, determine compensability, and manage reserves and settlements. The role involves negotiating within authority, coordinating with attorneys, and supporting return-to-work efforts to minimize expenses while complying with regulations.

The candidate should have a bachelor's degree in a related field, 3+ years in workers' compensation, and strong analytical, communication, and

Qualifications

• Bachelor's degree in a related field.
• Relevant combination of education and experience may be considered in lieu of degree.
• Continuous learning as defined by the company's philosophy is required.
• Certification or progress toward certification is highly preferred and encouraged.

Responsabilités

• Verifies workers' compensation coverage of employers and injured employees.
• Determines compensability under workers' compensation by thorough investigation of the claim.
• Determines causal relationship between injury and incident to ensure appropriate payment of benefits.
• Facilitate return to work for the injured employee.
• Establishes timely and appropriate reserves based on the profile of the claim within given authority.
• Documents specifics of claims with potential for subrogation recovery.
• Manages medical bills for non-indemnity and indemnity claims.
• Approves payment based on treatment plan and medical support showing relationship to injury.
• Concludes and closes files to meet internal standards while complying with state law.
• Negotiates settlements with attorneys or injured parties within authority at earliest possible point.
• Works with manager on complex files above settlement/reserve authority.
• Manages outside vendors to contain costs.
• Maintains effective relationships with internal/external customers.
• Stays abreast of changes in workers' compensation statutes and case law.

Connaissances

Negotiation

Communication

Customer service

Analytical thinking

Multi-tasking

Independent work

Formation

Bachelor's degree in related field

Certifications preferred

Description du poste

AF Group seeks a Claim Representative II to handle moderately difficult workers' compensation claims, verify coverage, determine compensability, and manage reserves and settlements. The role involves negotiating within authority, coordinating with attorneys, and supporting return-to-work efforts to minimize expenses while complying with regulations.

The candidate should have a bachelor's degree in a related field, 3+ years in workers' compensation, and strong analytical, communication, and