Remote Workers' Comp Claims Specialist II

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

Job summary

AF Group seeks an intermediate-level claims handler to manage workers' compensation cases with moderate to high complexity. You will assess compensability, investigate incidents, and determine causality to ensure accurate benefit payments.

You will work with internal teams and external attorneys, negotiate settlements, manage reserves, and mentor junior staff while staying current with state laws and company policies.

Qualifications

• Three (3) years of experience in a workers' compensation claims environment.
• Bachelor's degree in a related field.
• Certification or progress toward certification is highly preferred and encouraged.
• Bilingual skills preferred.
• One (1) year of AF Group Claims Representative I experience.

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

Negotiation

Investigation

Communication

Analytical skills

Education

Bachelor's degree in a related field

Certification in progress or preferred

Job description

AF Group seeks an intermediate-level claims handler to manage workers' compensation cases with moderate to high complexity. You will assess compensability, investigate incidents, and determine causality to ensure accurate benefit payments.

You will work with internal teams and external attorneys, negotiate settlements, manage reserves, and mentor junior staff while staying current with state laws and company policies.