Senior Workers' Comp Claims Specialist

AF - Group; United States; On-site; USD 57,000 - 95,000; Full time

Job summary

AF Group is seeking a Claim Representative II to manage workers’ compensation claims, verify coverage, investigate, determine compensability, and negotiate settlements. The role focuses on timely reserves, cost containment, and maintaining strong relationships with clients and vendors.

The position requires a Bachelor’s degree or equivalent experience, 3 years’ experience in workers’ compensation claims, and is based in an office setting with limited travel. Bilingual skills are a plus.

Qualifications

• Bachelor’s degree in a related field or equivalent experience.
• Three years’ experience in a workers’ compensation claims environment or one year at AF Group Claims Representative I.
• Bilingual skills preferred.

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.
• 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.
• 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.
• 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

Computer skills

Medical terminology

Workers' comp laws

Communication

Customer service

Negotiation

Time management

Attention to detail

Teamwork

Decision making

Problem solving

Education

Bachelor’s degree in a related field

Job description

AF Group is seeking a Claim Representative II to manage workers’ compensation claims, verify coverage, investigate, determine compensability, and negotiate settlements. The role focuses on timely reserves, cost containment, and maintaining strong relationships with clients and vendors.

The position requires a Bachelor’s degree or equivalent experience, 3 years’ experience in workers’ compensation claims, and is based in an office setting with limited travel. Bilingual skills are a plus.