Claims Representative II – Workers' Comp Expert

AF Group; Houston (TX); Remote; USD 57,000 - 95,000; Full time

Job summary

AF Group seeks an experienced Claim Representative II to handle intermediate-level workers' compensation claims. You will investigate, determine compensability, and negotiate settlements while managing reserves and supporting return-to-work efforts.

Role requires thorough investigation, strong analytical skills, and the ability to manage multiple priorities with attention to detail. Office-based position with potential for advancement within claims leadership.

Qualifications

• Bachelor's degree in a related field required or equivalent experience.
• Continuous learning as defined by company philosophy is required.
• Certification or progress toward certification highly preferred and encouraged.

Responsibilities

• Verifies workers' compensation coverage of employers and injured employees.
• Determines compensability under workers' compensation by thorough investigation.
• Determines causal relationship between injury and incident to ensure proper benefits.
• Facilitates return to work for the injured employee.
• Establishes timely reserves based on claim profile within authority.
• Documents specifics of claims with potential subrogation recovery.
• Manages medical bills for related claims.
• Approves payment based on treatment plan and relation to injury.
• Closes files to meet internal standards and comply with state laws.
• Negotiates settlements within authority and with attorneys.
• Works with manager on complex files above settlement/reserve authority.
• Manages outside vendors to control costs.
• Maintains relationships with internal and external customers.
• Keeps abreast of changes in workers' comp statutes and case law.

Skills

Negotiation

Investigation

Communication

Multi-tasking

Analytical

Customer service

Independent work

Education

Bachelor's degree in related field

Tools

Company software

Job description

AF Group seeks an experienced Claim Representative II to handle intermediate-level workers' compensation claims. You will investigate, determine compensability, and negotiate settlements while managing reserves and supporting return-to-work efforts.

Role requires thorough investigation, strong analytical skills, and the ability to manage multiple priorities with attention to detail. Office-based position with potential for advancement within claims leadership.