Senior Claim Representative I

Blue Cross Blue Shield of Michigan; Northern (KY); Hybrid; USD 72,000 - 120,000; Full time

Job summary

AF Group is seeking a technical expert in the claim handler career path to independently manage complex and catastrophic claims, including coverage issues. The role requires navigating high-stakes scenarios and collaborating with clients, agents, and attorneys.

Under limited supervision, you will mentor teammates, manage reserves, and drive results across the claims workflow. Travel to client sites is expected as part of the role.

Qualifications

• Bachelor’s degree in a related field; relevant combination of education and experience may be considered in lieu of degree.
• Continuous learning required per company philosophy; certification is highly preferred and encouraged.

Responsibilities

• Independently administers complex claims and catastrophic exposures within authority, including large accounts.
• Establishes timely reserves based on claim profile and exposure.
• Represents the Company by resolving complex claim issues with customers, agents and brokers.
• Negotiates settlements with attorneys and settles cases prior to mediation or litigation.
• Manages outside vendors to support cost containment.
• Maintains effective relationships with internal and external customers.
• Stays informed about changes in statutes and case law.
• Mentors team members and may act as department leader in management's absence.

Skills

Negotiation

Leadership

Communication

Customer service

Decision making

Mentoring

Analytical skills

Conflict resolution

Time management

Training

Education

Bachelor’s degree in a related field

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.

#LI-CD1

#AFG