Claim Specialist II: Complex, High-Touch Claims

AF - Group; Michigan; On-site; USD 57,000 - 95,000; Full time

Job summary

AF Group in Michigan is seeking Claim Representatives I/II/III to manage workers’ compensation claims across ENTRY to ADVANCED levels. The role covers medical and indemnity benefits, investigation, and settlements within defined authority, with opportunities to mentor teammates as you progress.

Responsibilities include verifying coverage, assessing compensability, establishing reserves, and negotiating settlements while maintaining compliance with state laws and company policies.

Qualifications

• Bachelor’s degree in a related field; combination of education and experience may be considered.
• Minimum one-year relevant experience; bilingual skills preferred.

Responsibilities

• Verifies workers’ compensation coverage of employers and injured employees.
• Determines compensability under workers’ compensation by thorough investigation of the claim.
• Establishes timely and appropriate reserves based on the profile of the claim within given authority.
• Negotiates settlements with attorneys or injured parties within given authority at the earliest possible point.
• Mentors lower-level claim handlers and coordinates special projects.

Skills

Computer skills

Medical terminology

Workers’ compensation laws

Communication skills

Customer service

Negotiation

Multitasking

Attention to detail

Independent work

Education

Bachelor’s degree in related field

Certification preferred

Job description

AF Group in Michigan is seeking Claim Representatives I/II/III to manage workers’ compensation claims across ENTRY to ADVANCED levels. The role covers medical and indemnity benefits, investigation, and settlements within defined authority, with opportunities to mentor teammates as you progress.

Responsibilities include verifying coverage, assessing compensability, establishing reserves, and negotiating settlements while maintaining compliance with state laws and company policies.