Remote Workers' Comp Claims Specialist II

AF Group; New York (NY); Remote; USD 57,000 - 95,000; Full time

Job summary

AF Group is seeking an intermediate-level claims handler focused on workers' compensation. The role handles moderate to difficult claims, performing thorough investigations to determine compensability and reserve levels, and negotiating settlements within authority.

Jurisdiction in California is required for this remote US-based position. The candidate will verify coverage, manage medical bills, and coordinate returns-to-work while staying compliant with state laws and agency guidelines.

Qualifications

• Bachelor's degree in a related field; continuous learning encouraged.
• Three years' experience in a workers' compensation claims environment with necessary skills.
• Experience handling claims in 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 reserves based on the profile of the claim within given authority.
• 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.
• Other relevant essential functions may be required.

Skills

Computer skills

Legal terminology

Workers' comp laws

Communication skills

Negotiation skills

Multi-tasking

Independent decision making

Education

Bachelor's degree

Job description

AF Group is seeking an intermediate-level claims handler focused on workers' compensation. The role handles moderate to difficult claims, performing thorough investigations to determine compensability and reserve levels, and negotiating settlements within authority.

Jurisdiction in California is required for this remote US-based position. The candidate will verify coverage, manage medical bills, and coordinate returns-to-work while staying compliant with state laws and agency guidelines.