Remote Senior Workers' Comp Claims Specialist

AF Group; Houston (TX); Hybrid; USD 57,000 - 95,000; Full time

Job summary

AF Group is seeking an intermediate-level workers' compensation claims handler. You will verify coverage, evaluate compensability, and determine reserves. The role involves negotiating settlements, coordinating with attorneys, and guiding complex cases to resolution within authority.

You will also mentor teammates, manage medical bills, and stay current with evolving statutes. This hybrid position offers remote work flexibility with typical office collaboration and compliance requirements.

Qualifications

• Bachelor's degree in a related field is required or considered with equivalent experience.
• Certification or progress toward certification is highly preferred and encouraged.
• Three years of experience in a workers' compensation claims environment with investigation, review, and closure experience.
• Experience handling claims across multiple jurisdictions is preferred.
• Bilingual skills are a plus.

Responsibilities

• Verify workers' compensation coverage for employers and injured employees.
• Determine claim compensability by thorough investigation.
• Assess causal relationship between injury and incident to ensure proper benefits.
• Facilitate return to work for injured employees.
• Establish timely reserves within authorized limits based on claim exposure.
• Document claim details and potential subrogation recoveries.
• Manage medical bills for indemnity and non-indemnity claims.
• Approve payments based on treatment plans and medical justification.
• Close files in compliance with internal standards and state laws.
• Negotiate settlements with attorneys or parties within authority.
• Collaborate with managers on complex files and above-reserve cases.
• Coordinate with outside vendors for cost containment.
• Maintain relationships with internal and external customers.
• Stay updated on workers' compensation statutes and case law.

Skills

Negotiation skills

Communication skills

Multi-priority management

Analytical skills

Attention to detail

Independent work

Team collaboration

Education

Bachelor's degree in related field

Certification or progress toward certification

Job description

AF Group is seeking an intermediate-level workers' compensation claims handler. You will verify coverage, evaluate compensability, and determine reserves. The role involves negotiating settlements, coordinating with attorneys, and guiding complex cases to resolution within authority.

You will also mentor teammates, manage medical bills, and stay current with evolving statutes. This hybrid position offers remote work flexibility with typical office collaboration and compliance requirements.