Senior WC Claim Specialist (CA) - Complex & High-Touch

Blue Cross Blue Shield of Michigan; Northern (KY); Hybrid; USD 65,000 - 109,000; Full time

Job summary

AF Group seeks an experienced advanced-level claims handler for workers’ compensation claims. The role involves investigating complex claims, determining compensability, and negotiating settlements within authority.

Mentoring junior staff and coordinating special projects are key aspects of the job. The candidate should have a bachelor’s degree (certifications preferred) and at least five years in workers’ compensation, with multi-jurisdiction experience and bilingual skills a plus.

Qualifications

• Bachelor’s degree with continuous learning preferred.
• ],
• job_responsibilities_description:[

Responsibilities

• Verifies workers’ compensation coverage of employers and injured employees.
• Determines compensability through thorough investigation of the claim.
• Determines causal relationship between injury and incident for appropriate payment.
• Facilitates return to work for the injured employee.
• Establishes reserves within given authority based on anticipated financial exposure.
• Documents claim specifics with potential subrogation recovery.
• Manages medical bills for indemnity and non-indemnity claims.
• Concludes and closes files to meet performance standards.
• Negotiates settlements within authority at earliest point.
• Mentors team members and acts as backup for team leader.
• Coordinates special projects and manages outside vendors.
• Maintains relationships with internal and external customers.
• Stays updated on workers’ compensation laws and rehabilitation advances.
• Mentors others and conducts audits of claim files.

Skills

Workers’ compensation laws

Legal terminology

Negotiation

Mentoring

Education

Bachelor’s degree or equivalent

Certification preferred

Tools

Computer proficiency

Job description

AF Group seeks an experienced advanced-level claims handler for workers’ compensation claims. The role involves investigating complex claims, determining compensability, and negotiating settlements within authority.

Mentoring junior staff and coordinating special projects are key aspects of the job. The candidate should have a bachelor’s degree (certifications preferred) and at least five years in workers’ compensation, with multi-jurisdiction experience and bilingual skills a plus.