Claim Representative II - Michigan

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

Job summary

Blue Cross Blue Shield of Michigan is seeking a Claim Representative II to handle moderate to difficult property and casualty claims, determine liability, reserve appropriately, and negotiate settlements within authority. The role supports remote work with occasional on-site visits to insured municipalities and requires Michigan residency.

You will review coverages, investigate claims, manage subrogation opportunities when present, and coordinate with managers on complex files.

Qualifications

• Three years of property and casualty claims experience.
• Experience reviewing policies and exclusions, investigating, and settling losses.
• Bilingual skills preferred.

Responsibilities

• Verifies coverage of claimed property and casualty damage.
• Determines liability for covered claims by thorough investigation.
• Establishes reserves within given authority based on exposure.
• Negotiates settlements with attorneys or injured parties within authority.
• Works with manager on complex files and cost containment.

Skills

Computers & software

Medical terminology

Legal terminology

Michigan municipal liability

Negotiation & dispute resolution

Communication skills

Multi-tasking & deadlines

Attention to detail

Independent work / team collaboration

Education

Bachelor’s degree in related field

Tools

Policy administration software

MS Office

Job description

SUMMARY:

Claim Representative II:

This is the intermediate level of the claim handler career path. Handles moderate to difficult claims. Exercises progressively more discretion in the determination of compensability of claims.Considers many factors in the determination claim reserves. Negotiates and settles claims within given authority. Works remotely with occasional travel to on-site visits with insured municipalities. Is a resident in the State of Michigan

RESPONSIBILITIES/TASKS:

• Verifies coverage of claimed property and casualty damage.
• Determines liability for covered claims by thorough investigation of the claim and applicable exclusions.
• Analyzes liability for claims pursuant to Michigan municipal liability statutes and caselaw.
• Establishes timely and appropriate reserves based on the profile of the claim within given authority based on anticipated financial exposure.
• Documents specifics of claims with potential for subrogation recovery, including amount of potential recovery monies.
• Manages estimates and invoices for property, casualty and automobile claims, and approves payments based on support showing relationship to the cause of loss and legal liability for payment.
• Concludes and closes files following resolution of claims to meet internal performance standards while complying with state legislation to avoid penalties and manage expenses.
• Negotiates settlements with attorneys or injured parties within given authority at the earliest possible point to bring cases to final disposition.
• Works closely with manager on complex files or files above settlement/reserve authority.
• Manages outside vendors to ensure cost containment efforts.
• Establishes and maintains effective workingrelationships with all internal and external customers.
• Stays abreast of changes in municipal liability statutes and case law in order to accurately interpret and apply relevant laws.

ADDITIONAL RESPONSIBILITIES/TASKS:

• Administers complex claims and catastrophic exposures within authority, including claims from dedicated large accounts.
• Exercises independent judgment to settle cases prior to mediation or litigation.
• Actively participates in agent/client relationship management.
• Assists in mentoring team members.

This position description identifies the responsibilities and tasks typically associated with the performance of the position. Other relevant essential functions may be required.

EMPLOYMENT QUALIFICATIONS

EDUCATION OR EQUIVALENT EXPERIENCE:

Bachelor’s degree in a related field.Relevant combination of education and experience may be considered in lieu of degree.Continuous learning, as defined by the Company’s learning philosophy, is required. Certification or progress toward certification is highly preferred and encouraged.

EXPERIENCE:

Claim Representative II:

Three years experience in property and casualty claims environment which provides the necessary skills, knowledge and abilities, such as experience in reviewing policy coverages and exclusions, drafting coverage letters, investigating and settling property and casualty losses, and adjusting claims through litigation and trial. Experience handling claims in multiple jurisdictions preferred. Bilingual skills preferred.

SKILLS/KNOWLEDGE/ABILITIES (SKA) REQUIRED:

• Ability and proficiency in the use of computers and company standard software specific to position.
• Knowledge of medical and legal terminology related to the work.
• Knowledge of Michigan municipal liability.
• Knowledge of best practices for adjusting property losses.
• Effective oral and written communication skills.
• Effective customer service skills.
• Ability to negotiate, build consensus and resolve conflict.
• Ability to manage multiple priorities and meet established deadlines.
• Attention to detail and analytical skills.
• Ability to work independently as well as within a team.

ADDITIONAL SKILLS/KNOWLEDGE/ABILITIES (SKA) REQUIRED:

Claim Representative II, III:

• Ability to make independent decisions.
• Ability to solve complex problems.

WORKING CONDITIONS:

Work is performed in an office setting or remote with no unusual hazards. Minimal travel required.

PAY RANGE:

Actual compensation decision relies on the consideration of internal equity, candidate’s skills and professional experience, geographic location, market, and other potential factors. It is not standard practice for an offer to be at or near the top of the range, and therefore a reasonable estimate for this role is between $56,700 - $94,900.

The qualifications listed above are intended to represent the minimum education, experience, skills, knowledge and ability levels associated with performing the duties and responsibilities contained in this job description.

We are an Equal Opportunity Employer. Diversity is valued and we will not tolerate discrimination or harassment in any form. Candidates for the position stated above are hired on an "at will" basis. Nothing herein is intended to create a contract.

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