Entry-Level Workers' Comp Claims Specialist

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

Job summary

AF Group is seeking an entry-level professional claim handler for workers' compensation. The role focuses on medical and indemnity benefits, with discretion in compensability decisions and reserving. You will negotiate settlements within authority and support return-to-work initiatives.

Qualifications include a bachelor’s degree, and at least one year of relevant experience or completion of a claims trainee program. Bilingual skills are preferred.

Qualifications

• Bachelor's degree required; related experience may be considered in lieu of degree.
• At least 1 year of relevant experience or completion of a claims trainee program.
• Continuous learning as defined by company policy is required.
• Certification or progress toward certification is preferred.
• Bilingual skills are preferred.

Responsibilities

• Verifies workers' compensation coverage for employers and injured employees.
• Determines compensability through thorough investigation of the claim.
• Assesses causal relationship between injury and incident to ensure proper benefits.
• Facilitates return to work for the injured employee.
• Establishes reserves based on claim profile within authority and anticipated exposure.
• Documents claim specifics including potential subrogation recovery.
• Manages medical bills for non-indemnity and indemnity claims.
• Approves payments based on treatment plans and medical support linked to the injury.
• Closes files after resolution to meet internal standards and comply with state laws.
• Negotiates settlements with attorneys or parties within authority to reach final disposition.
• Collaborates with manager on complex files and those above settlement/reserve authority.
• Manages outside vendors to support cost containment.
• Maintains relationships with internal and external customers.
• Keeps abreast of workers' compensation statutes, case law, and rehab advances.

Skills

Attention to detail

Negotiation

Analytical thinking

Communication skills

Bilingual (preferred)

Education

Bachelor's degree in a related field

Tools

Claims software

Job description

AF Group is seeking an entry-level professional claim handler for workers' compensation. The role focuses on medical and indemnity benefits, with discretion in compensability decisions and reserving. You will negotiate settlements within authority and support return-to-work initiatives.

Qualifications include a bachelor’s degree, and at least one year of relevant experience or completion of a claims trainee program. Bilingual skills are preferred.