Workers' Comp Claims Specialist II - Negotiation

AF Group; Minneapolis (MN); Remote; USD 57,000 - 95,000; Full time

Job summary

AF Group in Minneapolis, MN is seeking a Claim Representative II to handle moderately difficult workers' compensation claims. You will verify coverage, assess compensability, determine causality, and negotiate settlements within your authority while coordinating with medical providers and clients.

This intermediate role requires solid investigation, return-to-work facilitation, reserves management, and collaboration with managers on complex files.

Qualifications

• Bachelor's degree in related field required.
• Combination of education and experience may be considered in lieu of degree.
• Continuous learning as defined by company policy 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 investigation of the claim.
• Determines causal relationship between injury and incident to ensure payment of benefits.
• Facilitate return to work for the injured employee.
• Establishes timely reserves within given authority based on claim profile.
• Documents specifics of claims with potential for subrogation recovery.
• Manages medical bills for indemnity and non-indemnity claims.
• Approves payment based on medical plan and treatment relation to injury.
• Concludes and closes files to meet performance standards while complying with state laws.
• Negotiates settlements with attorneys or injured parties within authority.
• Works with manager on complex files above settlement/reserve authority.
• Manages outside vendors to contain costs.
• Maintains relationships with internal and external customers.
• Stays updated on workers' compensation statutes and case law.

Skills

Computer proficiency

Medical terminology

Workers' comp laws

Communication skills

Customer service

Negotiation

Multi-tasking

Attention to detail

Independent work

Teamwork

Education

Bachelor's degree

Continuous learning

Certification encouraged

Job description

AF Group in Minneapolis, MN is seeking a Claim Representative II to handle moderately difficult workers' compensation claims. You will verify coverage, assess compensability, determine causality, and negotiate settlements within your authority while coordinating with medical providers and clients.

This intermediate role requires solid investigation, return-to-work facilitation, reserves management, and collaboration with managers on complex files.