Remote Workers' Comp Claim Specialist II

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

Job summary

AF Group is seeking an experienced intermediate claim handler to adjudicate workers' compensation claims remotely in the United States. The role involves assessing coverage, determining compensability and causation, and negotiating settlements within authority while ensuring timely reserves and proper documentation.

The ideal candidate has California claim experience, strong negotiation skills, and the ability to manage complex files and vendor relationships, all while staying compliant with

Qualifications

• Bachelor's degree in a related field.
• Certification or progress toward certification is highly preferred.
• Continuous learning as defined by the Company's philosophy is required.

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 injury and incident to ensure correct payment of benefits.
• Facilitates return to work for the injured employee.
• Establishes timely reserves based on the profile of the claim within authority.
• Documents specifics of claims with potential for subrogation recovery, including potential amounts.
• Manages medical bills for non-indemnity and indemnity claims related to the injury.
• Approves payment based on treatment plan and medical support.
• Closes files to meet internal standards and comply with state laws.
• Negotiates settlements within authority to bring cases to disposition.
• Works with manager on complex files and higher-reserve cases.
• Manages outside vendors to support cost containment.
• Maintains relationships with internal and external customers.
• Keeps up with changes in workers' compensation statutes and case law.

Skills

Computer skills

Medical terminology

Workers' comp law

Oral & written communication

Customer service

Negotiation

Multitasking

Attention to detail

Independent decision making

Problem solving

Education

Bachelor's degree

Job description

AF Group is seeking an experienced intermediate claim handler to adjudicate workers' compensation claims remotely in the United States. The role involves assessing coverage, determining compensability and causation, and negotiating settlements within authority while ensuring timely reserves and proper documentation.

The ideal candidate has California claim experience, strong negotiation skills, and the ability to manage complex files and vendor relationships, all while staying compliant with