Mid-Level Workers’ Comp Claims Specialist

AF Group; Sacramento (CA); On-site; USD 57,000 - 95,000; Full time

Job summary

AF Group is seeking Claim Representatives at multiple levels to handle workers' compensation claims, from entry through advanced expertise. Responsibilities include verifying coverage, investigating causality, determining compensability, and coordinating reserves and settlements with growing autonomy.

You will work closely with managers on complex files, mentor junior staff, and ensure timely, compliant adjudication.

Qualifications

• Bachelor's degree or equivalent experience required.
• Experience in workers' compensation claims environment highly preferred.
• Continuous learning as defined by company's philosophy is required.

Responsibilities

• Verifies workers' compensation coverage of employers and injured employees.
• Determines compensability under workers' compensation by thorough investigation.
• Establishes reserves within authority based on claim profile.
• Negotiates settlements with attorneys or injured parties within authority.
• Coordinates with manager on complex files or above settlement/reserve authority.
• Manages medical bills for related claims and ensures payment accuracy.

Skills

Computer skills

Medical terminology

Legal terminology

Workers' compensation laws

Oral communication

Written communication

Customer service

Negotiation

Time management

Attention to detail

Analytical skills

Teamwork

Education

Bachelor's degree

Tools

Company software

Job description

AF Group is seeking Claim Representatives at multiple levels to handle workers' compensation claims, from entry through advanced expertise. Responsibilities include verifying coverage, investigating causality, determining compensability, and coordinating reserves and settlements with growing autonomy.

You will work closely with managers on complex files, mentor junior staff, and ensure timely, compliant adjudication.