Claims Specialist II — Workers’ Compensation

AF Group; Chicago (IL); Remote; USD 57,000 - 95,000; Full time

Job summary

AF Group is seeking a Claim Representative II in Chicago to handle intermediate workers' compensation claims, investigate and determine compensability, and negotiate settlements within authority. You will assess coverage, establish reserves, and coordinate with medical providers and attorneys to ensure accurate benefit payment.

Responsibilities include mentoring teammates, managing complex files, and staying current with state laws.

Qualifications

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

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 reported injury and the 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 based on anticipated financial exposure.
• Documents specifics of claims with potential for subrogation recovery, including amount of potential recovery monies.
• Manages medical bills for non-indemnity and indemnity claims directly associated with the claimed injury.
• Approves payment based on knowledge of the treatment plan and medical support showing relationship of treatment to the injury.
• Concludes and closes files following resolution of claims to meet internal performance standards while complying with state legislation to avoid penalties and manage expenses.
• Negotiates settlements with attorneys or injured parties within given authority at the earliest possible point to bring cases to final disposition.
• Works closely with manager on complex files or files above settlement/reserve authority.
• Manages outside vendors to ensure cost containment efforts.
• Establishes and maintains effective working relationships with all internal and external customers.
• Stays abreast of changes in workers' compensation statutes, case law, and rehabilitation efforts/advancements to accurately interpret and apply relevant laws.
• Administers complex claims and catastrophic exposures within authority, including claims from dedicated large accounts.
• Exercises independent judgment to settle cases prior to mediation or litigation.
• Actively participates in agent/client relationship management.
• Assists in mentoring team members.

Skills

Computer skills

Medical terminology

WC laws

Communication skills

Customer service

Negotiation

Multitasking

Attention to detail

Teamwork

Decision making

Problem solving

Education

Bachelor's degree in a related field

Certification preferred

Job description

AF Group is seeking a Claim Representative II in Chicago to handle intermediate workers' compensation claims, investigate and determine compensability, and negotiate settlements within authority. You will assess coverage, establish reserves, and coordinate with medical providers and attorneys to ensure accurate benefit payment.

Responsibilities include mentoring teammates, managing complex files, and staying current with state laws.