Senior Complex Claims Leader

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

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.