Senior Workers’ Comp Claims Specialist

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

Job summary

Blue Cross Blue Shield of Michigan seeks an advanced level Claim Handler to investigate complex workers’ compensation claims and exercise discretionary determination of compensability. You will mentor peers, coordinate special projects, and ensure settlements comply with authority.

California experience is required. The role involves high-touch service for complex customers, requires strong negotiation skills, and collaboration with managers on intricate files.

Qualifications

• To perform this job successfully, an individual must be able to perform each essential duty satisfactorily.
• Bachelor’s degree in a related field; certification or progression toward certification is highly preferred.
• Five (5) years of experience in a workers’ compensation claims environment with multi-jurisdiction handling preferred.

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 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; approves payment based on medical support.
• Concludes and closes files following resolution of claims to meet performance standards.
• Negotiates settlements with attorneys or injured parties within authority at earliest possible point.
• Mentors team members and coordinates special projects.

Skills

Negotiation

Communication

Analytical skills

Mentoring

Decision making

Education

Bachelor's degree in related field

Certification preferred

Job description

Blue Cross Blue Shield of Michigan seeks an advanced level Claim Handler to investigate complex workers’ compensation claims and exercise discretionary determination of compensability. You will mentor peers, coordinate special projects, and ensure settlements comply with authority.

California experience is required. The role involves high-touch service for complex customers, requires strong negotiation skills, and collaboration with managers on intricate files.