Senior CA Workers’ Comp Claim Specialist (Mentor)

Blue Cross Blue Shield of Michigan; United States; Hybrid; USD 65,000 - 109,000; Full time

Job summary

Blue Cross Blue Shield of Michigan is seeking an experienced advanced level workers’ compensation claim handler to investigate claims, determine compensability, and exercise significant discretion in reserves and settlements. The role may involve high-touch, labor-intensive cases with large or complex clients, requiring thorough investigations and careful documentation.

The position includes mentoring lower-level handlers, coordinating special projects, and ensuring adherence to state laws while

Qualifications

• Bachelor’s degree in a related field or equivalent experience.
• Five years in workers’ compensation claims handling, multi-jurisdiction preferred.
• AF Group Claims Representative II experience or equivalent preferred.

Responsibilities

• Verifies workers’ compensation coverage and determines compensability through thorough investigation.
• Establishes reserves and negotiates settlements within authority for timely resolution.
• Documents claims details, including subrogation potential and treatment relationships.
• Mentors junior handlers and conducts audits of claim files.
• Coordinates with managers on complex files and coordinates special projects.
• Maintains relationships with internal/external customers and outside vendors.

Skills

Negotiation

Communication

Analytical skills

Teamwork

Decision making

Problem solving

Education

Bachelor’s degree or related field

Job description

Blue Cross Blue Shield of Michigan is seeking an experienced advanced level workers’ compensation claim handler to investigate claims, determine compensability, and exercise significant discretion in reserves and settlements. The role may involve high-touch, labor-intensive cases with large or complex clients, requiring thorough investigations and careful documentation.

The position includes mentoring lower-level handlers, coordinating special projects, and ensuring adherence to state laws while