Entry-Level Workers' Comp Claims Specialist

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

Job summary

AF - Group in Wisconsin is seeking an entry level professional claim handler focused on medical and indemnity benefits. You will exercise discretion in determining compensability, reserve estimation, and settlement within authority.

Responsibilities include verifying workers’ compensation coverage, investigating claims, assessing causality, facilitating return to work, and managing claims to meet internal standards while complying with state laws.

Qualifications

• Bachelor’s degree or combination of education and experience may be considered.
• Minimum one-year relevant experience or completion of claims trainee program.

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 injury and incident for appropriate benefits.
• Facilitate return to work for the injured employee.
• Establish timely reserves based on claim profile and authority.
• Document specifics of claims with potential for subrogation recovery.
• Manage medical bills for non-indemnity and indemnity claims; approve payments per plan.
• Close files to meet performance standards while complying with state laws.
• Negotiate settlements with attorneys or injured parties within authority.
• Collaborate with manager on complex files beyond settlement/reserve authority.
• Coordinate with outside vendors to contain costs.
• Maintain effective relationships with internal and external customers.
• Stay updated on workers’ compensation statutes and related laws.

Skills

Software knowledge

Medical terminology

Legal terminology

Communication skills

Negotiation

Multitasking

Education

Bachelor’s degree

Job description

AF - Group in Wisconsin is seeking an entry level professional claim handler focused on medical and indemnity benefits. You will exercise discretion in determining compensability, reserve estimation, and settlement within authority.

Responsibilities include verifying workers’ compensation coverage, investigating claims, assessing causality, facilitating return to work, and managing claims to meet internal standards while complying with state laws.