Senior Workers' Comp Claims Specialist

AF Group; Jackson (MS); Remote; USD 57,000 - 95,000; Full time

Job summary

AF Group seeks a Claim Representative II to handle intermediate-difficulty workers' compensation claims in a Mississippi environment. You will verify coverage, determine compensability, assess causality, and facilitate return to work, while establishing reserves within authority and managing related medical bills.

You will also negotiate settlements, manage complex files with supervision, and maintain external/internal relationships, staying current on applicable laws and regulations.

Qualifications

• Bachelor's degree in a related field or equivalent experience.
• Continuous learning as defined by the Company's learning philosophy is required.
• Certification or progress toward certification is highly preferred and encouraged.

Responsibilities

• Verify workers' compensation coverage of employers and injured employees.
• Determine compensability under workers' compensation by thorough investigation.
• Determine causal relationship between the reported injury and the incident to ensure appropriate payment of benefits.
• Facilitate 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 to accurately interpret and apply relevant laws.

Skills

Computer skills

Communication skills

Negotiation

Analytical skills

Attention to detail

Multitasking

Independent work

Teamwork

Decision making

Complex problem solving

Conflict resolution

Education

Bachelor's degree in a related field

Tools

Medical terminology

Legal terminology

Job description

AF Group seeks a Claim Representative II to handle intermediate-difficulty workers' compensation claims in a Mississippi environment. You will verify coverage, determine compensability, assess causality, and facilitate return to work, while establishing reserves within authority and managing related medical bills.

You will also negotiate settlements, manage complex files with supervision, and maintain external/internal relationships, staying current on applicable laws and regulations.