Claim Representative II

Blue Cross Blue Shield of Michigan; United States; On-site; USD 60,000 - 85,000; Full time

Job summary

AF Group is seeking an intermediate-level claims professional to handle workers’ compensation cases. The role involves verifying coverage, investigating claims for compensability, and managing related documentation.

The position emphasizes settlement negotiations, collaboration with management, and staying current with evolving statutes and case law to ensure compliant, timely resolutions.

Qualifications

• Bachelor’s degree in a related field; continuous learning, as defined by the Company’s learning philosophy, is required.
• Three (3) years of experience in a workers’ compensation claims environment which provides the necessary skills, knowledge and abilities.
• Certification or progress toward certification is highly desirable.

Responsibilities

• Verifies workers’ compensation coverage of employers and injured employees. Determines compensability under workers’ compensation by thorough investigation of the
• Documents specifics of claims with potential for subrogation recovery, including amount of potential recovery monies. Manages medical bills for ...
• 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 ...
• Stays abreast of changes in workers’ compensation statutes, case law and rehabilitation efforts/advancements in order to accurately interpret and apply relevant ...

Skills

Communication skills

Customer service

Negotiation

Conflict resolution

Claims handling

Education

Bachelor’s degree in a related field

Tools

Company standard software

Job description

Compensation: Competitive Compensation and Benefits Package

About Us

AF Group’s focused and passionate team uses industry-leading best practices, analytics and resources to manage risk and minimize loss for our policyholders while strengthening businesses with our valued independent agent partners.

We strive to continuously increase the long‑term value of our organization by outperforming our industry peers and fostering a culture of underwriting and claims excellence.

This is the intermediate level of the claim handler career path. Handles moderate to difficult claims. Exercises progressively more discretion in the determination of ...

Compensation

Actual compensation decision relies on the consideration of internal equity, candidate’s skills and professional experience, geographic location, market, and other ...

Responsibilities

Claims

Verifies workers’ compensation coverage of employers and injured employees.Determines compensability under workers’ compensation by thorough investigation of the ...

Administration

Documents specifics of claims with potential for subrogation recovery, including amount of potential recovery monies.Manages medical bills for ...

Management

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 ...

Performance

Stays abreast of changes in workers’ compensation statutes, case law and rehabilitation efforts/advancements in order to accurately interpret and apply relevant ...

Requirements

Education

Bachelor’s degree in a related field. Continuous learning, as defined by the Company’s learning philosophy, is required. Certification or progress toward certification is highly ...

Experience

Three (3) years of experience in a workers’ compensation claims environment which provides the necessary skills, knowledge and abilities, such as experience in reviewing ...

Skills

Effective oral and written communication skills.Effective customer service skills.Ability to negotiate, build consensus and resolve conflict.Ability to manage ...

Knowledge

Ability and proficiency in the use of computers and company standard software specific to position.Knowledge of medical and legal terminology related to ...

About Us

AF Group’s focused and passionate team uses industry-leading best practices, analytics and resources to manage risk and minimize loss for our policyholders while strengthening businesses with our valued independent agent partners.

We strive to continuously increase the long‑term value of our organization by outperforming our industry peers and fostering a culture of underwriting and claims excellence.