Senior Complex Claims Leader

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

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.