Remote Workers' Comp Claim Specialist II

AF Group; Winston-Salem (NC); Remote; USD 57,000 - 95,000; Full time

Job summary

AF Group is seeking an intermediate level claim handler for workers' compensation. The role handles moderate to difficult claims, determines compensability, negotiates settlements, and manages reserves within authority.

The position supports return-to-work efforts and works remotely in the United States, with California claim jurisdiction experience required though residence in CA is not required. The ideal candidate will have a bachelor's degree, several years in workers' compensation claims,

Qualifications

• Bachelor's degree in a related field.
• 3 years experience in workers' compensation claims.
• Experience handling claims across multiple jurisdictions preferred.
• Bilingual skills preferred.

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 and appropriate reserves based on the profile of the claim within given authority based on anticipated financial exposure.
• Documents specifics of claims with potential for subrogation recovery, including amount of 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.
• Concludes and closes files following resolution of claims to meet internal performance standards while complying with state legislation to avoid penalties and manage expenses.
• Negotiates settlements with attorneys or injured parties within given authority at the earliest possible point to bring cases to final disposition.
• Works closely with manager on complex files or files above settlement/reserve authority.
• Manages outside vendors to ensure cost containment efforts.
• Establishes and maintains effective working relationships with all internal and external customers.
• Stays abreast of changes in workers' compensation statutes, case law and rehabilitation efforts/advancements in order to accurately interpret and apply relevant laws.
• Administers complex claims and catastrophic exposures within authority, including claims from dedicated large accounts.
• Exercises independent judgment to settle cases prior to mediation or litigation.
• Actively participates in agent/client relationship management.
• Assists in mentoring team members.

Skills

Computers/Software

Medical/Legal terminology

Workers' compensation laws

Communication skills

Negotiation

Multitasking

Independent decision making

Education

Bachelor's degree in a related field

Job description

AF Group is seeking an intermediate level claim handler for workers' compensation. The role handles moderate to difficult claims, determines compensability, negotiates settlements, and manages reserves within authority.

The position supports return-to-work efforts and works remotely in the United States, with California claim jurisdiction experience required though residence in CA is not required. The ideal candidate will have a bachelor's degree, several years in workers' compensation claims,