Sr. Subro Claim Rep I

Blue Cross Blue Shield of Michigan; United States; Ibrido; USD 65.000 - 95.000; Tempo pieno

Descrizione del lavoro

Blue Cross Blue Shield of Michigan seeks an experienced Subrogation Examiner II/Senior to actively manage workers’ compensation subrogation claims. You will investigate liability, evaluate damages, negotiate settlements, and drive files toward final disposition with a strong emphasis on confidentiality and timely action.

The role requires knowledge of subrogation processes, medical and legal terminology, and the ability to handle multiple priorities in a dynamic environment.

Competenze

• Bachelor’s degree in insurance, business or related field; continuous learning expected.
• Certification or progress toward professional designation is preferred.

Mansioni

• Investigates, analyzes, determines potential liability, and settles with adverse parties.
• Completes other duties and special projects as requested.
• Recommends and advocates positions on subrogation claims.
• Develops and manages claim action plans to resolution and approves payments.
• Updates databases and prepares reports with standard software.
• Communicates with workers compensation claims handlers; negotiates settlements within authority.
• Exhibits independent judgment to settle cases prior to mediation or litigation.

Conoscenze

Subrogation process

Medical terminology

Deadline management

Analytical thinking

Negotiation

Confidentiality

Team collaboration

Formazione

Bachelor’s degree in insurance or related field

Descrizione del lavoro

SUMMARY:

Responsible for the proactive management of worker’s compensation subrogation claims. Exercises significant discretion in the determination of liability and value of claim.Negotiates and settles with claimants and/or attorneys, within authority, at earliest possible point to bring cases to final disposition.

RESPONSIBILITIES/TASKS:

• Investigates, analyzes, determines potential liability, and effectively settles with adverse parties.


• Completes other duties and special projects as requested.


• Recommends, plans and advocates a position on workers compensation subrogation claims assigned.


• Develops and manages subrogation claim action plans to resolution, coordinates claim processes and approves claim payments.


• Supports the team by acting as back up to the Subrogation Examiner II and Senior.


• Updates databases and prepares reports utilizing standard software.


• Communicates and collaborates with workers compensation claims handlers.


• Negotiates and settles claims within authority, at the earliest possible point to bring cases to final disposition.


• Exercises sufficient and independent judgment to settle cases prior to mediation and/or litigation.


• Obtains all necessary documentation from the appropriate parties within established timelines.


• Properly assesses the cause of action, collectible damages, and liability and expense exposures.


• Composes correspondence and various reports in the management of subrogation claims.


• Responsible for final disposition of the claim including the use of arbitration or litigation.


• Remains abreast of new case law and statutes affecting subrogation.


• Maintains confidentiality of information processed.

Additional Subrogation Examiner II Responsibilities/Tasks:

• Manages the administration of complex claims and catastrophic exposures, within authority, including claims generated from dedicated large accounts.


• Assists in the development of reporting, analysis and conducts education & training programs as it relates to subrogation.


• Engages in assisting the mentoring of other team members.


• Represents the subrogation team on various committees and projects.


• Directs claims administration efforts within statutory, procedural, case law, contractual and/or philosophical guidelines.


• Provides leadership regarding case law understanding for subrogation team.

Additional Senior Subrogation Examiner Responsibilities/Tasks:

• Provides guidance and advice when required or necessary and encourage/motivate employees in their daily efforts.


• Serves as a technical expert for the subrogation team.


• Acts as back-up for team manager.


• Coordinates special projects on behalf of management, as assigned.


• Provides training sessions for team and/or other business units, as required.

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’sdegree in insurance, business or a related field.Progress towards, or completion of, industry-recognized professional designation preferred.Combination of relevant education and experience may be considered in lieu of degree.Continuous learning required, as defined by the Company’s learning philosophy. Certification, or progress toward, highly preferred and encouraged.

EXPERIENCE:

With proper education, no experience is required; however, one-year of relevant experience which provides the necessary skills, knowledge and abilities is preferred.

Additional Subrogation Examiner II Experience:

Three years' experience in an insurance organization including demonstrated knowledge of Subrogation.

Combination of relevant skills and experience may be considered in lieu of insurance organization experience.

Additional Senior Subrogation Examiner Experience:

Seven years' experience in an insurance organization including demonstrated knowledge of Subrogation.Progress toward or completion of industry recognized professional designations preferred.One year working in supervision, or lead role preferred. Combination of relevant skills and experience may be considered in lieu of insurance organization experience.

SKILLS/KNOWLEDGE/ABILITIES (SKA) REQUIRED:

• Knowledge of subrogation process.


• Knowledge of basic medical and legal terminology.


• Ability to manage multiple priorities and adapt to changing workflow in order to still meet deadlines and goals are essential.


• Ability to collect and analyze relevant information and based on the analysis make efficient and effective decisions.


• Excellent customer service and organizational skills are essential.


• Ability to function effectively in a team environment.


• Ability to establish and maintain effective working and client relationships.


• Ability to negotiate with opposing parties and to resolve conflicts in a professional manager.


• Ability to maintain confidentiality as appropriate.

Additional Subrogation Examiner II (SKA) Required:

• Excellent oral and written communication skills with the ability to effectively communicate with providers, attorneys, agents and policyholders. Ability to function effectively in a multi-functional team environment.


• Advanced knowledge of medical and legal terminology.


• Ability to assist in training and mentoring of others.


• Knowledge of the applicability of relevant laws and regulations.


• Extensive knowledge of the appropriate laws, regulatory authorities, industry trends and their impact.

Additional Senior Subrogation Examiner (SKA) Required:

• Ability to understand business needs and conceptualize and implement processes and procedures that support business strategies.


• Demonstrated superior judgment and analytical abilities.


• Ability to prepare periodic reports as requested.


• Ability to research workers compensation and subrogation laws, regulations or specific issues, in order to offer guidance or direction to others.


• Ability to comprehend the consequences of various problem situations and address them.


• Ability to take a lead role and/or assist in training and mentoring of others.


• Demonstrated expertise regarding subrogation claim handling.


• Demonstrated leadership abilities.

WORKING CONDITIONS:

• Work is performed in an office setting or remote with no unusual hazards.Some travel may be required.


• The above statements are intended to describe the general nature and level of work being performed by people assigned to this classification. They are not intended to be construed as an exhaustive list of all responsibilities, duties and skills required of personnel so classified. This job description does not constitute a contract for employment.


• We are an Equal Opportunity Employer. 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

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