Senior Workers Comp Claims Specialist – CA Expert

AF Group; Philadelphia (Philadelphia County); Remote; USD 65,000 - 109,000; Full time

Job summary

AF Group is seeking an advanced level workers' compensation claim handler to investigate and determine compensability, establish reserves, and negotiate settlements within authority. The role involves guiding complex cases, mentoring junior handlers, coordinating special projects, and overseeing medical bill management to ensure proper benefits.

Candidates should have strong investigative, negotiation, and communication skills, with extensive experience in multi-jurisdictional claims and a

Qualifications

• Five (5) years of experience in a workers' compensation claims environment with investigation and closing complex claims.
• Bachelor's degree or equivalent combination of education and experience; certification is preferred.

Responsibilities

• Investigates and determines compensability of workers' compensation claims.
• Establishes reserves and negotiates settlements within authority.
• Mentors lower-level claim handlers and coordinates special projects.
• Manages medical bills and ensures appropriate payment based on treatment plans.
• Collaborates with managers on complex files and external vendors.

Skills

Investigative skills

Negotiation

Communication

Mentoring

Education

Bachelor's degree in related field

Certification progress preferred

Job description

AF Group is seeking an advanced level workers' compensation claim handler to investigate and determine compensability, establish reserves, and negotiate settlements within authority. The role involves guiding complex cases, mentoring junior handlers, coordinating special projects, and overseeing medical bill management to ensure proper benefits.

Candidates should have strong investigative, negotiation, and communication skills, with extensive experience in multi-jurisdictional claims and a