Junior Claims Specialist – Medical & Indemnity

AF - Group; Lansing (MI); On-site; USD 48,000 - 81,000; Full time

Job summary

AF - Group is seeking an entry-level professional claim handler in Michigan. The role handles medical and indemnity benefits with discretion in determining compensability and reserves, aiming to settle within authority.

The position requires a related bachelor's degree, and at least one year of relevant experience or completion of a claims trainee program. Bilingual skills are a plus, with strong emphasis on accuracy and cost containment.

Qualifications

• Bachelor’s degree in a related field; certification or progress toward certification is highly preferred and encouraged.
• Minimum one-year relevant experience that provides the necessary skills, knowledge and abilities or completion of claims trainee program; bilingual skills 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.
• 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 terminology

Workers' comp laws

Communication

Negotiation

Multitasking

Detail oriented

Teamwork

Education

Bachelor's degree

Job description

AF - Group is seeking an entry-level professional claim handler in Michigan. The role handles medical and indemnity benefits with discretion in determining compensability and reserves, aiming to settle within authority.

The position requires a related bachelor's degree, and at least one year of relevant experience or completion of a claims trainee program. Bilingual skills are a plus, with strong emphasis on accuracy and cost containment.