Senior Workers' Comp Claim Specialist - Remote

ViziRecruiter,LLC.; California (MO); On-site; USD 65,000 - 109,000; Full time

Job summary

AF Group is seeking an experienced claims professional at an advanced level to manage workers’ compensation claims with high complexity, using substantial discretion in adjudication and reserves. The role includes mentoring peers, guiding escalated cases, and coordinating special projects while ensuring regulatory compliance.

The candidate must have California experience and be able to handle large, labor-intensive file loads with accuracy and sound judgment under authority limits.

Qualifications

• Requires experience in reviewing, investigating and closing complex workers’ compensation claims.
• Experience handling claims in multiple jurisdictions preferred.
• Knowledge of workers’ compensation laws and regulations.

Responsibilities

• Verifies workers’ compensation coverage of employers and injured employees.
• Determines compensability by thorough investigation of the claim.
• Establishes timely and appropriate reserves based on the profile of the claim within given authority.
• Negotiates settlements with attorneys or injured parties within given authority.
• Mentors team members and coordinates special projects.
• Maintains effective working relationships with internal and external customers.
• Stays abreast of changes in workers’ compensation statutes and case law.

Skills

Communication skills

Negotiation

Analytical skills

Independent work

Education

Bachelor’s degree in related field

Certification or progress toward certification

Job description

AF Group is seeking an experienced claims professional at an advanced level to manage workers’ compensation claims with high complexity, using substantial discretion in adjudication and reserves. The role includes mentoring peers, guiding escalated cases, and coordinating special projects while ensuring regulatory compliance.

The candidate must have California experience and be able to handle large, labor-intensive file loads with accuracy and sound judgment under authority limits.