Entry Claims Specialist – Workers’ Comp (Remote)

Blue Cross Blue Shield of Michigan; Wisconsin; In loco; USD 48.000 - 81.000; Tempo pieno

Descrizione del lavoro

Blue Cross Blue Shield of Michigan is seeking an entry-level professional to handle workers’ compensation claims (medical and indemnity). The role involves discretion in determining compensability and establishing claim reserves.

You will verify coverage, determine compensability, and work with attorneys or claimants to settle within authority, while ensuring timely closures and cost containment.

Competenze

• Bachelor’s degree in a related field; combination of education and experience may be considered.
• Minimum one year of relevant experience; bilingual skills preferred.

Mansioni

• Verify workers’ compensation coverage for employers and injured employees.
• Determine compensability through thorough investigation of the claim.
• Assess causal relationship between injury and incident to ensure payment of benefits.
• Facilitate return to work for the injured employee.
• Establish timely reserves based on the claim profile within authority.
• Manage medical bills for non-indemnity and indemnity claims.
• Close files after resolution to meet performance standards and control costs.
• Negotiate settlements within authority to bring cases to final disposition.
• Coordinate with managers on complex files and with outside vendors to contain costs.
• Stay updated on changes in workers’ compensation statutes and related case law.

Conoscenze

Computer proficiency

Medical terminology

Workers' compensation laws

Communication skills

Customer service

Negotiation

Time management

Formazione

Bachelor’s degree in a related field

Descrizione del lavoro

Blue Cross Blue Shield of Michigan is seeking an entry-level professional to handle workers’ compensation claims (medical and indemnity). The role involves discretion in determining compensability and establishing claim reserves.

You will verify coverage, determine compensability, and work with attorneys or claimants to settle within authority, while ensuring timely closures and cost containment.