Entry-Level Workers' Comp Claims Specialist

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 claims handler focused on workers’ compensation, handling medical and indemnity benefits with discretion in compensability and reserves. The role involves investigation, profit-conscious settlements, and coordination with managers on complex files.

The candidate should have a related bachelor’s degree and at least one year of relevant experience or a claims trainee program, with bilingual skills preferred.

Qualifications

• Bachelor’s degree in a related field; certification encouraged.
• Minimum one-year relevant experience or completion of claims trainee program; bilingual preferred.
• Knowledge of workers’ compensation laws and regulations.

Responsibilities

• Verify workers’ compensation coverage of employers and injured employees.
• Determine compensability under workers’ compensation by investigation of the claim.
• Determine causal relationship between injury and incident to ensure proper payment.
• Facilitate return to work for the injured employee.
• Establish timely reserves within authority based on claim profile.
• Document specifics of claims with potential for subrogation recovery.
• Manage medical bills for non-indemnity and indemnity claims related to the injury.
• Conclude and close files after resolution to meet performance standards.
• Negotiate settlements with attorneys or injured parties within authority.
• Collaborate with manager on complex files above settlement/reserve authority.
• Manage outside vendors to support cost containment.
• Maintain effective relationships with internal and external customers.
• Stay updated on workers’ compensation statutes and case law.

Skills

Computer skills

Medical/legal terminology

WC laws

Communication

Customer service

Negotiation

Multitasking

Attention to detail

Teamwork/Independence

Education

Bachelor's degree

Claims trainee program / experience

Job description

Blue Cross Blue Shield of Michigan is seeking an entry-level claims handler focused on workers’ compensation, handling medical and indemnity benefits with discretion in compensability and reserves. The role involves investigation, profit-conscious settlements, and coordination with managers on complex files.

The candidate should have a related bachelor’s degree and at least one year of relevant experience or a claims trainee program, with bilingual skills preferred.