Remote Workers’ Comp Claims Specialist II

Blue Cross Blue Shield of Michigan; United States; Remote; USD 57,000 - 95,000; Full time

Job summary

Blue Cross Blue Shield of Michigan is seeking an intermediate level claim handler responsible for moderate to difficult workers’ compensation claims. This remote US-based role requires knowledge of California statutes and the ability to determine compensability, reserves, and settlements within authority.

The position emphasizes investigation, negotiation with attorneys, return-to-work facilitation, and coordination with vendors, with opportunities to mentor teammates and stay current on

Qualifications

• Ability and proficiency in the use of computers and company standard software specific to position.
• Knowledge of medical and legal terminology related to the work.
• Knowledge of workers’ compensation laws and regulations, including jurisdictional laws.
• Effective oral and written communication skills.
• Effective customer service skills.
• Ability to negotiate, build consensus and resolve conflict.
• Ability to manage multiple priorities and meet established deadlines.
• Attention to detail and analytical skills.
• Ability to work independently as well as within a team.
• Ability to make independent decisions.
• Ability to solve complex problems.

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.
• Administers complex claims and catastrophic exposures within authority, including claims from dedicated large accounts.
• Exercises independent judgment to settle cases prior to mediation or litigation.
• Actively participates in agent/client relationship management.
• Assists in mentoring team members.

Education

Bachelor’s degree in a related field

Job description

Blue Cross Blue Shield of Michigan is seeking an intermediate level claim handler responsible for moderate to difficult workers’ compensation claims. This remote US-based role requires knowledge of California statutes and the ability to determine compensability, reserves, and settlements within authority.

The position emphasizes investigation, negotiation with attorneys, return-to-work facilitation, and coordination with vendors, with opportunities to mentor teammates and stay current on