Senior Workers' Compensation Claims Specialist

Blue Cross Blue Shield of Michigan; United States; Remote; USD 57,000 - 95,000; Full time

Job summary

Blue Cross Blue Shield of Michigan seeks a Claim Representative II to handle intermediate-level workers’ compensation claims. You will verify coverage, determine compensability, assess causality, and facilitate return to work while building accurate reserves and managing costs.

The role requires three years’ experience in workers’ comp claims, a related bachelor’s degree, and strong negotiation and communication skills. Hybrid work may be available depending on location.

Qualifications

• Bachelor’s degree in a related field. Certification preferred is encouraged.
• Three years’ experience in a workers’ compensation claims environment with skills in review, investigation, and closure.
• Bilingual skills preferred.

Responsibilities

• Verifies workers’ compensation coverage of employers and injured employees.
• Determines compensability under workers’ compensation by thorough investigation.
• Assesses causal relationship between injury and incident for benefits.
• Facilitates return to work for the injured employee.
• Establishes timely and appropriate reserves based on claim profile and authority.
• Documents claim specifics with potential subrogation recovery.
• Manages medical bills for non-indemnity and indemnity claims.
• Concludes files and closes cases to meet performance standards and comply with law.
• Negotiates settlements within authority at earliest disposition when possible.
• Works with manager on complex files and above settlement/reserve authority.
• Manages outside vendors to contain costs.
• Maintains relationships with internal and external customers.
• Keeps current with workers’ compensation statutes and related laws.

Skills

Computer skills

Medical terminology

Legal terminology

Workers' comp laws

Oral and written communication

Customer service

Negotiation

Multitasking

Attention to detail

Teamwork

Education

Bachelor's degree

Job description

Blue Cross Blue Shield of Michigan seeks a Claim Representative II to handle intermediate-level workers’ compensation claims. You will verify coverage, determine compensability, assess causality, and facilitate return to work while building accurate reserves and managing costs.

The role requires three years’ experience in workers’ comp claims, a related bachelor’s degree, and strong negotiation and communication skills. Hybrid work may be available depending on location.