Remote Workers' Comp Claim Specialist II

AF Group; Philadelphia (Philadelphia County); Remote; USD 57,000 - 95,000; Full time

Job summary

AF Group is seeking an intermediate-level Workers’ Compensation claim handler for a remote US-based role. You’ll handle moderate to difficult claims, exercise discretion to determine compensability, and negotiate settlements within authority while maintaining case timelines.

Qualified candidates will have California claims experience, minimal travel, and strong analytical, negotiation, and communication skills.

Qualifications

• Bachelor's degree or equivalent combination of education and experience.
• Continuous learning and certification encouraged.

Responsibilities

• Verify workers' compensation coverage.
• Investigate claims to determine compensability.
• Determine causal relationship to ensure proper benefits.
• Facilitate return to work for injured employees.
• Establish reserves within authority according to claim profile.
• Manage medical billing for indemnity and non-indemnity claims.
• Approve payments based on treatment plans and medical support.
• Close files in compliance with state laws and internal standards.
• Negotiate settlements within authority to bring cases to final disposition.

Skills

Computer proficiency

Medical terminology

Legal terminology

Regulatory knowledge

Communication

Negotiation

Prioritization

Independent decision making

Education

Bachelor's degree in a related field

Tools

Company standard software

Job description

AF Group is seeking an intermediate-level Workers’ Compensation claim handler for a remote US-based role. You’ll handle moderate to difficult claims, exercise discretion to determine compensability, and negotiate settlements within authority while maintaining case timelines.

Qualified candidates will have California claims experience, minimal travel, and strong analytical, negotiation, and communication skills.