Senior Workers' Comp Claims Specialist - Remote

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

Job summary

AF Group in the United States is seeking an advanced claim handler with significant discretion in determining compensability. The role involves investigation, reserving, settlement, and mentoring other handlers. Requires California experience and the ability to manage high-complexity files.

You will collaborate with managers on complex cases, coordinate with outside vendors, and stay current on workers’ compensation laws and practices to ensure accurate claims resolution.

Qualifications

• Bachelor’s degree in a related field required.
• Five years of workers’ compensation claims experience including complex claims.
• Two years of AF Group Claims Representative II experience with discretion.

Responsibilities

• Verifies workers’ compensation coverage of employers and injured employees.
• Determines compensability under workers’ compensation by thorough investigation.
• Determines causal relationship between the injury and incident for payment.
• Facilitates return to work for the injured employee.
• Establishes timely reserves based on claim profile within authority.
• Documents details of claims with potential for subrogation.
• Manages medical bills for indemnity and non-indemnity claims.
• Negotiates settlements within authority to final disposition.
• Audits claim files and mentors team members.
• Acts as backup for team leader and coordinates special projects.

Skills

Negotiation

Communication

Multitasking

Attention to detail

Analytical skills

Independence

Teamwork

Decision making

Problem solving

Mentoring

Education

Bachelor’s degree in a related field

Certification encouraged

Job description

AF Group in the United States is seeking an advanced claim handler with significant discretion in determining compensability. The role involves investigation, reserving, settlement, and mentoring other handlers. Requires California experience and the ability to manage high-complexity files.

You will collaborate with managers on complex cases, coordinate with outside vendors, and stay current on workers’ compensation laws and practices to ensure accurate claims resolution.