Senior Workers' Comp Claim Specialist

AF - Group; California (MO); On-site; USD 65,000 - 109,000; Full time

Job summary

AF Group seeks an experienced advanced claim handler in California to investigate complex workers’ compensation claims and determine compensability with discretion. You will mentor junior staff, coordinate projects, and manage settlements within authority, handling high-touch, labor-intensive cases.

The role requires strong negotiation skills, CA experience, and the ability to balance reserves with potential subrogation opportunities, while ensuring compliance with state laws.

Qualifications

• Bachelor’s degree in related field required; certification preferred.
• Five years of workers’ compensation claims experience in a multi-jurisdiction environment.
• Bilingual skills are a plus and may be preferred.

Responsibilities

• Verifies workers’ compensation coverage of employers and injured employees.
• Determines compensability under workers’ compensation by thorough investigation.
• Determines causal relationship between injury and incident to ensure appropriate payments.
• Facilitates return to work for the injured employee.
• Establishes reserves based on claim profile within authority and financial exposure.
• Documents claim specifics with potential subrogation recovery.
• Manages medical bills for indemnity/non-indemnity claims and approves payment.
• Concludes and closes files to meet performance standards and comply with laws.
• Negotiates settlements with attorneys or injured parties within authority.
• Mentors team members and coordinates special projects.

Skills

Advanced claims handling

California workers' comp

Negotiation

Mentoring

Stakeholder management

Education

Bachelor’s degree in related field

Tools

Company standard software

Job description

AF Group seeks an experienced advanced claim handler in California to investigate complex workers’ compensation claims and determine compensability with discretion. You will mentor junior staff, coordinate projects, and manage settlements within authority, handling high-touch, labor-intensive cases.

The role requires strong negotiation skills, CA experience, and the ability to balance reserves with potential subrogation opportunities, while ensuring compliance with state laws.