Workers’ Comp Claims Specialist II — Resolve & Settle

AF - Group; South Carolina; On-site; USD 57,000 - 95,000; Full time

Job summary

AF Group in South Carolina seeks an intermediate-level claims handler to manage moderate and difficult workers’ compensation claims. You will exercise discretion in determining compensability, establish reserves within authority, and negotiate settlements with attorneys or injured parties.

The role requires a relevant education, 3 years in WC claims, and multi-jurisdiction experience is a plus; bilingual skills are preferred.

Qualifications

• Bachelor’s degree in a related field; certification or progress toward certification is encouraged.
• Three (3) years of experience in a workers’ compensation claims environment; multi-jurisdiction experience preferred; bilingual skills a plus.
• One (1) year of AF Group Claims Representative I experience that includes handling of difficult or complex claims.

Responsibilities

• Verifies workers’ compensation coverage.
• Determines compensability under workers’ compensation by thorough investigation.
• 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.
• 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 in order to accurately interpret and apply relevant laws.
• Administers complex claims and catastrophic exposures within authority, including claims from dedicated large accounts.
• Exercises independent judgment to settle cases prior to mediation or litigation.
• Actively participates in agent/client relationship management.
• Assists in mentoring team members.

Skills

Negotiation

Time management

Attention to detail

Analytical skills

Education

Bachelor’s degree in a related field

Certification preferred

Job description

AF Group in South Carolina seeks an intermediate-level claims handler to manage moderate and difficult workers’ compensation claims. You will exercise discretion in determining compensability, establish reserves within authority, and negotiate settlements with attorneys or injured parties.

The role requires a relevant education, 3 years in WC claims, and multi-jurisdiction experience is a plus; bilingual skills are preferred.