WC Claims Specialist II

AF Group; Los Angeles (CA); On-site; USD 57,000 - 95,000; Full time

Job summary

AF Group seeks Claim Representative I–III to handle workers' compensation claims from intake through resolution. Candidates will verify coverage, investigate causation, determine compensability, and coordinate medical benefits and return-to-work plans.

Responsibilities include establishing reserves, documenting claim details for subrogation, and negotiating settlements within authority. Opportunities exist to mentor peers and collaborate with management on complex files.

Qualifications

• Bachelor's degree in a related field; continuous learning required.
• Certification or progress toward certification is highly 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 injury and incident to ensure appropriate payment of benefits.
• Facilitates return to work for the injured employee.
• Establishes timely and appropriate reserves based on claim profile and authority.
• Documents claim specifics with potential subrogation recovery and medicals.
• Negotiates settlements with attorneys or injured parties within authority.
• Works with manager on complex files and coordinates outside vendors for cost containment.

Skills

Computer skills

Legal terminology

WC laws

Negotiation

Communication

Multi-tasking

Analytical skills

Documentation

Independent work

Team collaboration

Education

Bachelor's degree

Tools

Microsoft Office

CRM software

Job description

AF Group seeks Claim Representative I–III to handle workers' compensation claims from intake through resolution. Candidates will verify coverage, investigate causation, determine compensability, and coordinate medical benefits and return-to-work plans.

Responsibilities include establishing reserves, documenting claim details for subrogation, and negotiating settlements within authority. Opportunities exist to mentor peers and collaborate with management on complex files.