Advanced Workers' Comp Claims Specialist

AF Group; Kalamazoo (MI); Remote; USD 57,000 - 95,000; Full time

Job summary

AF Group in Michigan is seeking a Claim Representative II to handle moderately difficult workers' compensation claims with growing discretion in determining compensability and reserves. You will verify coverage and determine causal relationships to ensure accurate benefit payments.

The role involves negotiating settlements, coordinating medical care, and facilitating return-to-work while maintaining compliance with state laws and company standards.

Qualifications

• Bachelor's degree in a related field or equivalent combination of education and experience.
• Continuous learning and professional development are required.
• Certification progress is highly preferred and encouraged.

Responsibilities

• Verifies workers' compensation coverage of employers and injured employees.
• Determines compensability under workers' compensation by thorough investigation of the claim.
• Determines causal relationship between the injury and incident to ensure proper benefits.
• Facilitate return to work for the injured employee.
• Establishes timely and appropriate reserves based on claim profile within authority.
• Documents details 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.
• Concludes and closes files to meet performance standards and expenses.
• Negotiates settlements with attorneys or injured parties within authority.
• Works with manager on complex files above settlement/reserve authority.
• Manages outside vendors to contain costs.
• Maintains effective relationships with internal and external customers.
• Stays current on workers' compensation statutes and case law.

Skills

Workers' comp knowledge

Negotiation

Investigation

Communication

Multitasking

Regulatory knowledge

Education

Bachelor's degree

Continuous learning

Certification encouraged

Tools

Case management software

Computers

Job description

AF Group in Michigan is seeking a Claim Representative II to handle moderately difficult workers' compensation claims with growing discretion in determining compensability and reserves. You will verify coverage and determine causal relationships to ensure accurate benefit payments.

The role involves negotiating settlements, coordinating medical care, and facilitating return-to-work while maintaining compliance with state laws and company standards.