Remote Workers' Comp Claims Specialist II

AF Group; Philadelphia (Philadelphia County); Remote; USD 57,000 - 95,000; Full time

Job summary

AF Group in the United States is seeking an intermediate level workers' compensation claims handler to assess claims, determine compensability, and manage reserves and settlements. The role requires thorough investigation, cross-jurisdictional experience, and the ability to coordinate with medical providers and clients.

Responsibilities include verifying coverage, establishing reserves, negotiating settlements, and guiding claim resolution while staying current on relevant statutes.

Qualifications

• Bachelor's degree in a related field.
• Continuous learning as defined by the Company's learning philosophy is required.
• Certification or progress toward certification is highly preferred and encouraged.
• Three (3) years of experience in a workers' compensation claims environment with necessary skills.
• Experience handling claims in multiple jurisdictions preferred.
• Bilingual skills preferred.
• One (1) year of AF Group Claims Representative I experience handling difficult/complex claims.

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 authority.
• Documents specifics of claims with potential for subrogation recovery.
• Manages medical bills for non-indemnity and indemnity claims associated with the injury.
• Approves payment based on knowledge of the treatment plan and medical support.
• Concludes and closes files after resolution of claims to meet performance standards.
• Negotiates settlements with attorneys or injured parties within authority at earliest possible point.
• Works closely with manager on complex files or above settlement/reserve authority.
• Manages outside vendors to ensure cost containment.
• Maintains effective relationships with internal and external customers.
• Stays abreast of changes in workers' compensation statutes, case law and rehab efforts.
• Administers complex claims and catastrophic exposures within authority.
• Exercises independent judgment to settle cases prior to mediation or litigation.
• Participates in agent/client relationship management.
• Assists in mentoring team members.

Skills

Negotiation

Analytical thinking

Communication

Decision making

Multitasking

Independent work

Education

Bachelor's degree in a related field

Certification or progress toward certification

Tools

Company standard software

Job description

AF Group in the United States is seeking an intermediate level workers' compensation claims handler to assess claims, determine compensability, and manage reserves and settlements. The role requires thorough investigation, cross-jurisdictional experience, and the ability to coordinate with medical providers and clients.

Responsibilities include verifying coverage, establishing reserves, negotiating settlements, and guiding claim resolution while staying current on relevant statutes.