Entry-Level Workers' Comp Claim Specialist

AF Group; New Berlin (WI); On-site; USD 48,000 - 81,000; Full time

Job summary

AF Group in Wisconsin is seeking an entry-level professional to handle workers' compensation claims for medical and indemnity benefits. The role involves investigating, determining compensability, establishing reserves, negotiating settlements, coordinating with medical providers and attorneys, and ensuring compliance with state law.

This position emphasizes accuracy, timely processing, and collaboration with management on complex files.

Qualifications

• Bachelor’s degree in a related field or equivalent combination of education and experience.
• One year of relevant experience or completion of claims trainee program.
• Certification or progress toward certification is highly preferred and encouraged.

Responsibilities

• Verify workers' compensation coverage of employers and injured employees.
• Determine compensability under workers' compensation by thorough investigation of the claim.
• Determine causal relationship between the reported injury and the incident to ensure appropriate payment of benefits.
• Facilitate return to work for the injured employee.
• Establish timely and appropriate reserves based on the profile of the claim within given authority.
• Document specifics of claims with potential for subrogation recovery.
• Manage medical bills for non-indemnity and indemnity claims.
• Approve payment based on knowledge of treatment plan and relationship to injury.
• Conclude and close files after resolution to meet performance standards and comply with state laws.
• Negotiate settlements within authority at earliest possible point.
• Collaborate with manager on complex files.
• Manage outside vendors to contain costs.
• Maintain relationships with internal and external customers.

Skills

Computer literacy

Medical terminology

Negotiation

Communication

Time management

Education

Bachelor's degree in a related field

Job description

AF Group in Wisconsin is seeking an entry-level professional to handle workers' compensation claims for medical and indemnity benefits. The role involves investigating, determining compensability, establishing reserves, negotiating settlements, coordinating with medical providers and attorneys, and ensuring compliance with state law.

This position emphasizes accuracy, timely processing, and collaboration with management on complex files.