Remote Workers' Comp Claim Specialist II - Complex Claims

AF Group; Dallas (TX); Remote; USD 57,000 - 95,000; Full time

Job summary

AF Group is seeking an intermediate level claim handler for workers' compensation claims. The role handles moderate to difficult claims, exercises discretion in determinations, and negotiates settlements within authority while maintaining reserves and compliance.

Remote-based in the US with California jurisdiction experience required. Candidates should possess a Bachelor's degree and relevant claims experience, with bilingual skills a plus.

Qualifications

• Bachelor's degree in a related field is required or equivalent combination of education/experience.
• Certification or progress toward certification is highly preferred and encouraged.
• Continuous learning as defined by company philosophy is required.

Responsibilities

• Verifies workers' compensation coverage.
• Determines compensability by thorough investigation.
• Assesses causal relationship to ensure correct benefits.
• Facilitates return to work for injured employees.
• Establishes reserves within authority based on anticipated exposure.
• Documents potential subrogation recoveries.
• Manages medical bills for all related claims.
• Approves payments per treatment plan.

Skills

Computer skills

Medical terminology

Workers' comp laws

Communication skills

Negotiation

Time management

Attention to detail

Independent decision making

Problem solving

Education

Bachelor's degree in a related field

Tools

MS Office

Claims software

Job description

AF Group is seeking an intermediate level claim handler for workers' compensation claims. The role handles moderate to difficult claims, exercises discretion in determinations, and negotiates settlements within authority while maintaining reserves and compliance.

Remote-based in the US with California jurisdiction experience required. Candidates should possess a Bachelor's degree and relevant claims experience, with bilingual skills a plus.