Senior Workers' Comp Claims Specialist

Blue Cross Blue Shield of Michigan; Michigan; On-site; USD 57,000 - 95,000; Full time

Job summary

AF Group is seeking a Claims Representative to support entry to advanced levels in Michigan. The role covers medical and indemnity claims, applying discretion to compensability, reserves, and settlements. You will investigate, coordinate medical bills, and work with attorneys to bring cases to disposition.

The position emphasizes negotiation, mentoring, and collaboration with managers on complex files. Office-based role with minimal travel and opportunities for growth within a supportive team.

Qualifications

• Bachelor’s degree in a related field. Continuous learning required.
• Minimum one year of relevant experience or claims trainee program.
• Experience in workers’ compensation is preferred; bilingual skills helpful.

Responsibilities

• Verifies workers’ compensation coverage and determines compensability.
• Determines causal relationships to ensure appropriate benefits.
• Facilitates return to work and establishes reserves.
• Documents claim specifics and manages medical bills related to injury.
• Negotiates settlements within authority and coordinates with attorneys.
• Mentors lower-level staff and supports complex files and projects.

Skills

Computer use

Medical terminology

Legal terminology

Negotiation skills

Communication skills

Multi-tasking

Detail orientation

Education

Bachelor’s degree in a related field

Job description

AF Group is seeking a Claims Representative to support entry to advanced levels in Michigan. The role covers medical and indemnity claims, applying discretion to compensability, reserves, and settlements. You will investigate, coordinate medical bills, and work with attorneys to bring cases to disposition.

The position emphasizes negotiation, mentoring, and collaboration with managers on complex files. Office-based role with minimal travel and opportunities for growth within a supportive team.