Remote Claims Specialist — Workers' Comp & Settlements

AF Group; Kalamazoo (MI); On-site; USD 57,000 - 95,000; Full time

Job summary

AF Group in Kalamazoo, MI seeks an intermediate level claims handler to assess moderate to difficult workers' compensation claims and determine compensability with thorough investigations. The role involves negotiating settlements within authority, managing reserves, and coordinating with medical providers and attorneys to finalize cases.

Ideal candidates have a Bachelor's degree in a related field and at least 3 years in workers' compensation, with certification encouraged.

Qualifications

• Bachelor's degree in a related field.
• 3 years of experience in a workers' compensation claims environment.
• Certification or progress toward certification is highly preferred and encouraged.

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 reserves based on the profile of the claim within given authority.
• Documents specifics of claims with potential for subrogation recovery and potential recovery monies.
• Manages medical bills for non-indemnity and indemnity claims directly associated with the claimed injury.
• Approves payment based on knowledge of the treatment plan and medical support showing relationship of treatment to the injury.

Skills

Negotiation

Analytical skills

Communication

Education

Bachelor's degree in related field

3 years workers' comp claims experience

Certification preferred

Job description

AF Group in Kalamazoo, MI seeks an intermediate level claims handler to assess moderate to difficult workers' compensation claims and determine compensability with thorough investigations. The role involves negotiating settlements within authority, managing reserves, and coordinating with medical providers and attorneys to finalize cases.

Ideal candidates have a Bachelor's degree in a related field and at least 3 years in workers' compensation, with certification encouraged.