Entry-Level Remote Claims Adjuster

Blue Cross Blue Shield of Michigan; Northern (KY); Hybrid; USD 48,000 - 81,000; Full time

Job summary

Blue Cross Blue Shield of Michigan is seeking an entry-level professional to handle workers’ compensation claims (medical and indemnity) with discretion in determinations and reserves. You will negotiate settlements within authority and coordinate with medical providers and attorneys to support timely resolutions.

The role emphasizes accuracy, timely documentation, and ability to work independently or in a team, with remote or office options and ongoing learning opportunities in a supportive

Qualifications

• Bachelor’s degree in a related field; a mix of education and experience may substitute.
• Minimum one year of relevant experience or completion of claims trainee program; bilingual is a plus.

Responsibilities

• Verifies workers’ compensation coverage of employers and injured employees.
• Determines compensability under workers’ compensation by thorough investigation.
• Determines causal relationship between injury and incident to ensure proper payment.
• Facilitates return to work for the injured employee.
• Establishes timely reserves based on claim profile within authority.
• Documents specifics of claims with potential for subrogation recovery.
• Manages medical bills for non-indemnity and indemnity claims related to injury.
• Concludes and closes files to meet performance standards and comply with laws.
• Negotiates settlements with attorneys or injured parties within authority.
• Works with manager on complex files or those above settlement/reserve authority.
• Manages outside vendors to support cost containment.
• Maintains effective relationships with internal and external customers.
• Stays current on workers’ compensation statutes and case law.

Skills

Computer proficiency

Medical terminology

Workers' comp laws

Communication skills

Customer service

Negotiation

Time management

Attention to detail

Teamwork / independence

Education

Bachelor’s degree in related field

Claims trainee program / 1 year experience

Job description

Blue Cross Blue Shield of Michigan is seeking an entry-level professional to handle workers’ compensation claims (medical and indemnity) with discretion in determinations and reserves. You will negotiate settlements within authority and coordinate with medical providers and attorneys to support timely resolutions.

The role emphasizes accuracy, timely documentation, and ability to work independently or in a team, with remote or office options and ongoing learning opportunities in a supportive