Claims Specialist II — Workers’ Compensation

Blue Cross Blue Shield of Michigan; Lansing (MI); On-site; USD 57,000 - 95,000; Full time

Job summary

AF Group in the United States is seeking an intermediate level claim handler to manage moderate to difficult workers’ compensation claims with discretion on compensability determinations and reserves. This role emphasizes accuracy, timely settlements, and collaboration with clients and attorneys.

Responsibilities include verifying coverage, investigating claims, establishing reserves, and negotiating settlements within authority, while mentoring teammates and maintaining relationships with

Qualifications

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

Responsibilities

• Verifies workers’ compensation coverage of employers and injured employees.
• Determines compensability under workers’ compensation by thorough investigation of the claim.
• Determines causal relationship between the reported injury and the incident to ensure appropriate payment of benefits.
• Negotiates settlements with attorneys or injured parties within given authority at the earliest possible point to bring cases to final disposition.

Skills

Communication skills

Customer service

Negotiation

Multitasking

Attention to detail

Education

Bachelor’s degree in a related field

Certification or progress toward certification

Job description

AF Group in the United States is seeking an intermediate level claim handler to manage moderate to difficult workers’ compensation claims with discretion on compensability determinations and reserves. This role emphasizes accuracy, timely settlements, and collaboration with clients and attorneys.

Responsibilities include verifying coverage, investigating claims, establishing reserves, and negotiating settlements within authority, while mentoring teammates and maintaining relationships with