Workers' Comp Claims Specialist II

AF Group; Dallas (TX); Remote; USD 57,000 - 95,000; Full time

Job summary

AF Group in Dallas, TX seeks a Claim Representative II to handle moderate-difficulty workers' compensation claims, exercising increasing discretion in determining compensability and reserving within authority.

Responsibilities include verifying coverage, investigating causation, facilitating return to work, negotiating settlements, managing medical bills, and coordinating with attorneys and vendors to contain costs.

Qualifications

• Bachelor's degree in a related field.
• Relevant combination of education and experience may be allowed in lieu of degree.
• Continuous learning, as defined by the company's philosophy, is required.
• Certification or progress toward certification is highly preferred and encouraged.

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.
• 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

Negotiation

Multitasking

Attention to detail

Independent work

Teamwork

Decision-making

Problem solving

Education

Bachelor's degree

Continuous learning

Certification preferred

Job description

AF Group in Dallas, TX seeks a Claim Representative II to handle moderate-difficulty workers' compensation claims, exercising increasing discretion in determining compensability and reserving within authority.

Responsibilities include verifying coverage, investigating causation, facilitating return to work, negotiating settlements, managing medical bills, and coordinating with attorneys and vendors to contain costs.