Advanced Workers' Comp Claims Specialist

AF Group; Las Vegas (NV); On-site; USD 57,000 - 95,000; Full time

Job summary

AF Group in Las Vegas seeks a Claim Representative II to handle intermediate-level workers' compensation claims, with CA/NV experience. You will verify coverage, assess compensability, and determine causal relationships to ensure proper benefit payments.

The role requires returning injured employees to work, setting reserves, and negotiating settlements within authority. Collaboration with managers and outside vendors is essential to manage costs and comply with state laws.

Qualifications

• Three years of workers' compensation claims experience.
• Experience handling claims across multiple jurisdictions preferred.
• Bilingual skills preferred.
• One year of AF Group Claims Representative I experience.

Responsibilities

• Verifies workers' compensation coverage.
• Determines claim compensability after investigation.
• Assesses causal relationship to ensure proper benefits.
• Facilitates return to work for the injured employee.
• Establishes reserves within authority based on risk.
• Manages medical bills for related claims.
• Negotiates settlements with attorneys within authority.
• Coordinates with vendors to control costs.
• Maintains relationships with internal and external customers.
• Stays updated on workers' comp laws.

Skills

Independent decision making

Problem solving

Bilingual abilities

Job description

AF Group in Las Vegas seeks a Claim Representative II to handle intermediate-level workers' compensation claims, with CA/NV experience. You will verify coverage, assess compensability, and determine causal relationships to ensure proper benefit payments.

The role requires returning injured employees to work, setting reserves, and negotiating settlements within authority. Collaboration with managers and outside vendors is essential to manage costs and comply with state laws.