Claims Specialist II — Remote Workers' Comp

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

Job summary

AF Group in the United States seeks an intermediate-level claim handler to manage moderate to difficult workers’ compensation claims. You will apply discretion in compensability and reserves, with a focus on timely resolutions and subrogation opportunities.

The role requires a Bachelor’s degree and 3 years of workers’ compensation experience, strong communication, negotiation, and the ability to work across jurisdictions. Remote work options may be available.

Qualifications

• Bachelor’s degree in a related field; continuous learning encouraged.
• Three (3) years of workers’ compensation claims experience; multi-jurisdiction experience preferred; bilingual skills a plus.
• Certification progress toward certification is highly preferred and encouraged.

Responsibilities

• Verifies workers’ compensation coverage of employers and injured employees.
• Determines compensability by thorough investigation of the claim.
• Determines causal relationship between injury and incident to ensure appropriate payment of benefits.
• Facilitates return to work for the injured employee.
• Establishes timely and appropriate reserves based on the claim profile and authority.
• Documents specifics of claims with potential for subrogation recovery.
• Manages medical bills for related claims and approves payments.
• Negotiates settlements within authority to bring cases to final disposition.
• Works with manager on complex files or cases above settlement authority.
• Manages outside vendors to contain costs and maintain relationships with customers.
• Stays updated on workers’ compensation statutes and related laws.

Skills

Oral & written communication

Customer service

Negotiation & conflict resolution

Education

Bachelor’s degree in a related field

Certification progress toward certification

Tools

Company standard software

Job description

AF Group in the United States seeks an intermediate-level claim handler to manage moderate to difficult workers’ compensation claims. You will apply discretion in compensability and reserves, with a focus on timely resolutions and subrogation opportunities.

The role requires a Bachelor’s degree and 3 years of workers’ compensation experience, strong communication, negotiation, and the ability to work across jurisdictions. Remote work options may be available.