Remote Workers' Comp Claims Specialist II

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

Job summary

AF Group is seeking an intermediate level workers' compensation claims handler. You will verify coverage, determine compensability, investigate injuries, and help facilitate return to work while establishing reserves within approved authority.

Candidates should have a bachelor's degree, at least three years in a claims environment, and strong negotiation, communication, and analytical skills. Certification is encouraged, bilingual ability is preferred, and some remote work with minimal travel is

Qualifications

• Bachelor's degree or equivalent required.
• Certification or progress toward certification highly preferred.
• Three years of workers' compensation claims experience preferred.
• 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 investigation of the claim.
• Determines causal relationship between injury and incident to ensure payment of benefits.
• Facilitates return to work for the injured employee.
• Establishes timely reserves based on claim profile within authority and exposure.
• Documents specifics of claims with potential for subrogation recovery.
• Manages medical bills for indemnity and non-indemnity claims.
• Approves payment based on treatment plan and relation to injury.
• Concludes and closes files post-resolution adhering to internal standards and state laws.
• Negotiates settlements within authority at earliest feasible point.
• Mentors team members and supports complex files with manager guidance.
• Manages outside vendors to support cost containment.

Skills

Negotiation

Analytical skills

Attention to detail

Communication skills

Multitasking

Independent decision making

Education

Bachelor's degree

Certification progress toward

Job description

AF Group is seeking an intermediate level workers' compensation claims handler. You will verify coverage, determine compensability, investigate injuries, and help facilitate return to work while establishing reserves within approved authority.

Candidates should have a bachelor's degree, at least three years in a claims environment, and strong negotiation, communication, and analytical skills. Certification is encouraged, bilingual ability is preferred, and some remote work with minimal travel is