Senior Workers' Compensation Claims Specialist

AF Group; New York (NY); Remote; USD 57,000 - 95,000; Full time

Job summary

AF Group seeks a Claim Representative II to handle moderately difficult workers' compensation claims. You will verify coverage, determine compensability through investigation, and assess causality to ensure proper payments.

Responsibilities include establishing reserves, managing medical bills, facilitating return-to-work, and negotiating settlements within authority while maintaining relationships with clients and adhering to state laws.

Qualifications

• Bachelor's degree in a related field or equivalent experience.
• Three years' workers' compensation claims experience preferred.
• Bilingual skills preferred.

Responsibilities

• Verify workers' compensation coverage for employers and injured employees.
• Determine compensability through thorough investigation of the claim.
• Assess causal relationships to ensure appropriate benefit payments.
• Facilitate return-to-work for the injured employee.
• Establish reserves within authority based on claim profile and exposure.
• Document claim specifics including potential subrogation recovery.
• Manage medical bills for indemnity and non-indemnity claims.
• Approve payments aligned with treatment plans and medical evidence.
• Close files after resolution to meet performance standards and comply with state law.
• Negotiate settlements with attorneys or parties within authority for early disposition.
• Collaborate with manager on complex files above settlement/reserve authority.
• Coordinate with outside vendors to support cost containment.
• Maintain effective relationships with internal and external customers.
• Stay current on workers' compensation statutes and case law.

Skills

Negotiation

Communication

Multitasking

Detail oriented

Independent work

Computer skills

Medical terminology

Customers service

Teamwork

Education

Bachelor's degree in a related field

Job description

AF Group seeks a Claim Representative II to handle moderately difficult workers' compensation claims. You will verify coverage, determine compensability through investigation, and assess causality to ensure proper payments.

Responsibilities include establishing reserves, managing medical bills, facilitating return-to-work, and negotiating settlements within authority while maintaining relationships with clients and adhering to state laws.