Advanced Workers' Comp Claims Specialist

Blue Cross Blue Shield of Michigan; Northern (KY, SC); Hybrid; USD 57,000 - 95,000; Full time

Job summary

AF Group seeks an intermediate workers’ compensation claims handler to assess coverage, determine compensability, and facilitate timely resolutions. You will review injuries, verify coverage, and determine causal links to ensure proper benefit payments, while supporting return-to-work efforts and managing reserves within authority.

The role requires multi-jurisdiction experience, strong negotiation skills, and the ability to work with attorneys and clients to settle cases efficiently.

Qualifications

• Bachelor’s degree or equivalent work experience and ongoing learning.
• Experience reviewing, investigating, and closing workers’ comp claims.
• Ability to handle complex claims and multi-jurisdiction work.
• Bilingual skills are a plus.

Responsibilities

• Verifies coverage and determines compensability through investigation.
• Assesses causal relationship to ensure proper benefits payment.
• Facilitates return to work for injured employees.
• Establishes reserves within authority based on exposure.
• Documents claims with potential for subrogation recovery.
• Manages medical bills related to the injury and treatment.
• Closes files to meet performance standards and avoid penalties.
• Negotiates settlements with attorneys or parties at appropriate authority level.
• Supports complex files with manager guidance.
• Manages outside vendors to contain costs.
• Maintains relationships with internal and external customers.

Skills

Computer proficiency

Medical terminology

Workers’ comp laws

Oral and written comms

Customer service

Negotiation

Multitasking

Attention to detail

Independent decision making

Problem solving

Education

Bachelor’s degree in a related field

Certification preferred

3 years workers’ comp claims experience

AF Group Claims Representative I experience (1 year)

Job description

AF Group seeks an intermediate workers’ compensation claims handler to assess coverage, determine compensability, and facilitate timely resolutions. You will review injuries, verify coverage, and determine causal links to ensure proper benefit payments, while supporting return-to-work efforts and managing reserves within authority.

The role requires multi-jurisdiction experience, strong negotiation skills, and the ability to work with attorneys and clients to settle cases efficiently.