Remote Workers' Comp Claims Specialist II

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

Job summary

AF Group is seeking an intermediate Claim Handler to manage moderate to difficult workers' compensation claims in a remote US-based role. The position requires jurisdiction experience in California and uses discretion to determine compensability, reserves, and settlements within authority.

You'll work with managers on complex files, coordinate with vendors, and ensure compliance with state laws while delivering timely resolutions.

Qualifications

• Bachelor's degree in a related field; continuous learning encouraged.
• Certification or progress toward certification is highly preferred.
• Three years' experience in workers' compensation claims is required; bilingual skills preferred.

Responsibilities

• Verify workers' compensation coverage and determine compensability.
• Investigate causal relationships to ensure proper benefits.
• Facilitate return to work and establish reserves within authority.
• Document facts, coordinate with medical providers, and manage bills.
• Negotiate settlements with attorneys or injured parties within authority.
• Mentor team members and manage complex files with manager support.

Skills

Negotiation

Prioritization

Attention to detail

Independent work

Decision making

Problem solving

Communication (oral/written)

Customer service

Workers' compensation laws

Medical/Legal terminology

Computer software proficiency

Education

Bachelor's degree in a related field

Job description

AF Group is seeking an intermediate Claim Handler to manage moderate to difficult workers' compensation claims in a remote US-based role. The position requires jurisdiction experience in California and uses discretion to determine compensability, reserves, and settlements within authority.

You'll work with managers on complex files, coordinate with vendors, and ensure compliance with state laws while delivering timely resolutions.