Senior Claim Representative I

Blue Cross Blue Shield of Michigan; Lansing (MI); On-site; USD 72,000 - 120,000; Full time

Job summary

Blue Cross Blue Shield of Michigan is seeking a technical expert in the claims handler career path. The role handles complex, catastrophic and high-touch claims with limited supervision, mentoring others and potentially acting as department leader in the absence of management.

Responsibilities include establishing reserves, negotiating settlements, and coordinating with customers, agents and brokers to resolve the most challenging issues while staying current with evolving statutes and case law.

Qualifications

• Bachelor’s degree required; related field preferred or equivalent experience.
• Continuous learning as defined by company policy; certification encouraged.
• Strong computer and software skills with ability to use company standard tools.

Responsibilities

• Independently manage complex and catastrophic claims within authority.
• Establish timely reserves based on claim profile and exposure.
• Represent the company with customers, agents, and brokers to resolve complex issues.
• Negotiate settlements with attorneys or claimants; settle before mediation or litigation when appropriate.
• Manage outside vendors to support cost containment and outcomes.
• Maintain strong relationships with internal and external customers.
• Stay updated on relevant statutes and case law affecting claims.
• Mentor and develop team members; may act as department leader in absence of management.

Skills

Negotiation

Leadership

Mentoring

Communication

Decision making

Attention to detail

Customer service

Conflict resolution

Multitasking

Education

Bachelor’s degree in a related field

Certification or progress toward certification (preferred)

Job description

This position serves as a technical expert in the claim handler career path. Under limited supervision, handles claims with litigation, complex/catastrophic and/or coverage elements. Handles the most unique cases, where little precedence has been established. May handle the most complex, high touch or labor-intensive customers. Serves as a department leader by developing other employees and may function as acting manager in the absence of department management.

• Independently administers complex claims and catastrophic exposures within authority, including claims from dedicated large accounts.
• Establishes timely and appropriate reserves based on claim profile and anticipated financial exposure.
• Represents the Company by working closely with customers, agents and brokers to resolve the most complex claim issues.
• Negotiates settlements with attorneys or injured and exercises independent judgment to settle cases prior to mediation or litigation.
• Manages outside vendors to ensure cost containment efforts.
• Establishes and maintains effective working relationships with all internal and external customers.
• Stays abreast of changes in relevant statutes and case law.
• Actively participates in agent/client relationship management.
• Mentors team members.
• May serve as department leader in the absence of management or act as manager designee.

EDUCATION

• 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

• Seven years of progressively more responsible experience in a claims environment that provides the necessary skills, knowledge and abilities. Experience handling claims in multiple jurisdictions preferred.Bilingual skills preferred. A concentration in commercial trucking would be preferred; ORTwo years of AF Group Claims Representative III experience that includes independent handling of the most complex claims and/or the most complex, high touch or labor-intensive customers.

QUALIFICATIONS

• Ability and proficiency in the use of computers and company standard software specific to position.
• Effective oral and written communication skills.
• Effective customer service skills.
• Ability to negotiate, build consensus and resolve conflict.
• Ability to act as a representative of the Company and establish effective working relationships.
• Ability to manage multiple priorities and meet established deadlines.
• Attention to detail and analytical skills.
• Ability to make independent decisions.
• Ability to solve highly complex problems.
• Ability to train and mentor others.
• Ability to lead others.

WORKING CONDITIONS:

Work is mostly performed in an office setting with no unusual hazards. Travel is required. Must be able to drive an automobile and have valid operator license. Specific vision abilities required by this job includes close vision, distance vision, color vision, and ability to adjust focus. While performing the duties of this job, the employee is frequently required to handle documents, books, manuals; reach with hands and arms; talk; and hear.

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.

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 $71,800 and $120,2000.

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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