Entry-Level Workers' Comp Claims Specialist

Blue Cross Blue Shield of Michigan; Wisconsin; Hybrid; USD 48,000 - 81,000; Full time

Job summary

Blue Cross Blue Shield of Michigan is seeking an entry-level professional claim handler specializing in workers' compensation. The role focuses on medical and indemnity benefits and involves determining compensability, reserves, and settlements within authority.

You will verify coverage, investigate claims, assess causal relationships, facilitate return-to-work, manage medical bills, and coordinate with attorneys and vendors. Strong communication and detail orientation are essential.

Qualifications

• Bachelor’s degree in a related field; continuous learning emphasized.
• Minimum one-year relevant experience or completion of claims trainee program; bilingual skills preferred.

Responsibilities

• Verify 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.
• Facilitates return to work for the injured employee.
• Establishes timely and appropriate reserves based on the profile of the claim within given authority based on anticipated financial exposure.
• Documents specifics of claims with potential for subrogation recovery, including amount of potential recovery monies.
• Manages medical bills for non-indemnity and indemnity claims directly associated with the claimed injury. Approves payment based on knowledge of the treatment plan and medical support showing relationship of treatment to the injury.
• Concludes and closes files following resolution of claims to meet internal performance standards while complying with state legislation to avoid penalties and manage expenses.
• Negotiates settlements with attorneys or injured parties within given authority at the earliest possible point to bring cases to final disposition.
• Works closely with manager on complex files or files above settlement/reserve authority.
• Manages outside vendors to ensure cost containment efforts.
• Establishes and maintains effective working relationships with all internal and external customers.
• Stays abreast of changes in workers’ compensation statutes, case law and rehabilitation efforts/advancements in order to accurately interpret and apply relevant laws.

Skills

Computer skills

Medical/Legal terminology

Workers' compensation laws

Communication skills

Customer service

Negotiation

Multitasking

Attention to detail

Teamwork

Education

Bachelor’s degree in related field

Claims trainee program

Job description

Blue Cross Blue Shield of Michigan is seeking an entry-level professional claim handler specializing in workers' compensation. The role focuses on medical and indemnity benefits and involves determining compensability, reserves, and settlements within authority.

You will verify coverage, investigate claims, assess causal relationships, facilitate return-to-work, manage medical bills, and coordinate with attorneys and vendors. Strong communication and detail orientation are essential.