Entry-Level Workers’ Comp Claims Specialist

AF - Group; United States; On-site; USD 48,000 - 81,000; Full time

Job summary

AF - Group is seeking an entry-level professional claim handler in the United States to manage medical and indemnity benefits. You will determine compensability, investigate claims, and negotiate settlements within your authority while coordinating with supervisors and vendors.

The role requires a Bachelor’s degree or equivalent experience, strong communication skills, and the ability to manage multiple claims with attention to detail. Training and growth opportunities are available.

Qualifications

• Bachelor’s degree required; relevant combination of education and experience may be considered in lieu of degree.
• Minimum one-year relevant experience or completion of a claims trainee program.
• Bilingual skills preferred.

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.
• Facilitates return to work for the injured employee.
• Establishes timely and appropriate reserves within 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 treatment plan.
• 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.

Skills

Computer skills

Med terminology

WC laws

Oral and written communication

Customer service

Negotiation

Multitasking

Analytical skills

Education

Bachelor’s degree in related field

Job description

AF - Group is seeking an entry-level professional claim handler in the United States to manage medical and indemnity benefits. You will determine compensability, investigate claims, and negotiate settlements within your authority while coordinating with supervisors and vendors.

The role requires a Bachelor’s degree or equivalent experience, strong communication skills, and the ability to manage multiple claims with attention to detail. Training and growth opportunities are available.