Remote Workers' Comp Claims Specialist II

Blue Cross Blue Shield of Michigan; Northern (KY); Hybrid; USD 57,000 - 95,000; Full time

Job summary

Blue Cross Blue Shield of Michigan is seeking an intermediate claims handler for a remote role in the United States. The position concentrates on workers’ compensation, handling moderate to difficult claims while exercising discretion in determining compensability and reserves.

Key tasks include verifying coverage, investigating claims to establish compensability, and negotiating settlements within authority. California claims experience is required for this role.

Qualifications

• Three years experience in a workers’ compensation claims environment
• Experience handling claims in multiple jurisdictions preferred
• Bilingual skills preferred
• Certification or progress toward certification is highly preferred and encouraged
• Continuous learning is required

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 injury and incident to ensure 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
• Documents specifics of claims with potential for subrogation recovery
• Manages medical bills for non-indemnity and indemnity claims
• Concludes and closes files to meet internal standards while complying with state laws
• Negotiates settlements within authority at earliest possible point
• Works with manager on complex files above settlement/reserve authority
• Manages outside vendors to control costs
• Maintains relationships with internal/external customers
• Stays updated on workers’ compensation statutes and case law
• Administers complex claims including large accounts
• Exercises independent judgment to settle cases before mediation or litigation
• Participates in agent/client relationship management
• Assists in mentoring team members

Skills

Computer skills

Medical terminology

Workers’ compensation laws

Communication skills

Negotiation

Multitasking

Attention to detail

Independent and team work

Decision making

Complex problem solving

Education

Bachelor’s degree in a related field

Job description

Blue Cross Blue Shield of Michigan is seeking an intermediate claims handler for a remote role in the United States. The position concentrates on workers’ compensation, handling moderate to difficult claims while exercising discretion in determining compensability and reserves.

Key tasks include verifying coverage, investigating claims to establish compensability, and negotiating settlements within authority. California claims experience is required for this role.