Sr. Subrogation Claim Representative II - REMOTE

Blue Cross Blue Shield of Michigan; Northern (KY); Remote; USD 83,000 - 138,000; Full time

Job summary

AF Group is seeking a Senior Subrogation Claim Representative II to lead and manage complex workers’ compensation subrogation claims, including catastrophic exposures. You will mentor teammates, collaborate with attorneys and carriers, and drive strategic settlements while maintaining regulatory compliance.

The role requires exceptional analytical abilities, leadership, and a track record of handling highly litigated losses across multiple jurisdictions.

Qualifications

• Experience in managing complex subrogation claims.
• Ability to interpret case law and statutes.
• Strong leadership and mentoring skills.

Responsibilities

• Investigate and settle complex subrogation claims.
• Lead teams on catastrophics and large accounts.
• Coordinate with attorneys, carriers, and stakeholders to maximize recovery.

Skills

Subrogation

Leadership

Negotiation

Analytics

Communication

Education

Bachelor's degree

Job description

SUMMARY

This position serves as technical expert in the subrogation claim representative career path. Under limited supervision, manages subrogation worker’s compensation claims with litigation, complex/catastrophic and/or coverage elements. Manages unique cases, where sometimes little precedence has been established. Serves as department leader by developing other employees and may function as acting manager in the absence of department management.

We are seeking an experienced workers’ compensation subrogation adjuster or bodily injury liability claims adjuster with a background in complex and litigated claims and negotiating settlements directly with personal injury attorneys and adverse carriers. Workers’ compensation subrogation experience is preferred; however, we will consider strong bodily injury candidates who have handled larger, litigated losses and are interested in transitioning those skills to subrogation.

This role identifies, investigates, evaluates, and pursues recovery opportunities and develops strategies to maximize recoveries. Candidates must independently analyze complex claim issues and understand, interpret, and apply statutes and case law to develop claim strategy and negotiate resolutions. Multi-state and multi-line experience is preferred.

This is a remote position requiring travel for team meetings 1-2 times per year and occasional in-person mediations.

ESSENTIAL DUTIES AND RESPONSIBILITIES

1. Independently investigates, analyzes, determines potential liability, and effectively settles with adverse parties.
2. Recommends, plans and advocates a position on complex worker’s compensation subrogation claims.
3. Develops and manages complex subrogation claim action plans to resolution, coordinates claim processes and approves claim payments.
4. Supports the team by acting as back-up to other subrogation team members and manager and is manager’s or director’s proxy when necessary.
5. Updates databases and prepares reports utilizing standard software.
6. Proactively communicates and collaborates with workers’ compensation claims handlers.
7. Negotiates and settles claims within authority, at the earliest possible point to bring cases to final disposition.
8. Exercises independent judgment to settle cases prior to mediation and/or litigation.
9. Obtains all necessary documentation from the appropriate parties within established timelines.
10. Properly assesses the cause of action, collectible damages, and liability and expense exposures.
11. Composes correspondence and various reports in the management of subrogation claims.
12. Remains abreast of new case law and statutes affecting subrogation.
13. Maintains confidentiality of information processed.
14. Mentor team members on complex files and files above their authority.
15. Works with Claims in participating in agent/client relationship management.
16. Manages the administration of complex claims and catastrophic exposures, within authority, including claims generated from dedicated large accounts.
17. Assists in the development of reporting, analysis and conducts education & training programs as it relates to subrogation.
18. Represents the subrogation team on various committees and projects.
19. Directs claims administration efforts within statutory, procedural, case law, contractual and/or philosophical guidelines.
20. Provides leadership regarding case law understanding for subrogation team.
21. Provides guidance and advice when required or necessary and encourage/motivate employees in their daily efforts.
22. Serves as a technical expert for the subrogation team.
23. Coordinates special projects on behalf of management, as assigned.
24. Provides training sessions for team and/or other business units, as required.

Additional Responsibilities for SENIOR SUBROGATION CLAIM REPRESENTATIVE II:

1. Leads catastrophic subrogation claims with large claim volume.
2. Handles the most unique cases, where little precedence has been established, requiring innovative administration and problem resolution.
3. May provide oversight to vendors.
4. May take lead role in claim projects or initiatives.
5. Conducts audits of claim files.
6. Acts as liaison to claim consultants as needed to support enterprise initiatives.

EDUCATION AND EXPERIENCE

1. Relevant combination of education and experience may be considered in lieu of degree.
2. Bachelor’sdegree in insurance, business or a related field.
3. Continuous learning, as defined by the Company’s learning philosophy, is required.
4. Certification or progress toward certification is highly preferred and encouraged.

Senior Subrogation Claim Representative II:

1. Ten (10) years of progressively more responsible experience in a workers’ compensation subrogation or subrogation claims environment with demonstrated knowledge of subrogation, or in a claims environment handling liability claims, that provides the necessary skills, knowledge and abilities, such as experience in reviewing, investigating and closing the most complex workers’ compensation subrogation claims.
2. Experience handling claims in multiple jurisdictions required.

OR

1. Minimum of three years of AF Group Senior Subrogation Claims Representative I experience that includes independent handling of the most complex subrogation claims.

QUALIFICATIONS

To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge, skill, and/or ability required. Reasonable accommodation may be made to enable individuals with disabilities to perform the essential functions.

OTHER SKILLS AND ABILITIES

1. Knowledge of subrogation process.
2. Ability to manage multiple priorities and adapt to changing workflow to still meet deadlines and goals are essential.
3. Ability to collect and analyze relevant information and based on the analysis make independent and effective decisions.
4. Excellent customer service and organizational skills are essential.
5. Ability to establish and maintain effective working and client relationships.
6. Ability to negotiate with opposing parties and to resolve conflicts in a professional manager.
7. Ability to maintain confidentiality as appropriate.
8. Excellent oral and written communication skills with the ability to effectively communicate with providers, attorneys, agents, company leadership and policyholders.
9. Ability to function effectively in a multi-functional team environment.
10. Advanced knowledge of medical and legal terminology.
11. Extensive knowledge of the applicability of relevant laws and regulations.
12. Extensive knowledge of the appropriate laws, regulatory authorities, industry trends and their impact.
13. Ability to understand business needs and conceptualize and implement processes and procedures that support business strategies.
14. Demonstrated superior judgment and analytical abilities.
15. Ability to prepare periodic reports as requested.
16. Ability to research workers compensation and subrogation laws, regulations or specific issues, in order to offer guidance or direction to others.
17. Ability to comprehend the consequences of various problem situations and address them.
18. Ability to take a lead role and/or assist in training and mentoring others.
19. Demonstrated expertise and superior ability in managing and resolving complex subrogation claims.
20. Demonstrated leadership abilities.

ADDITIONAL INFORMATION

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.

WORKING CONDITIONS:

Work is mostly performed in an office setting with no unusual hazards. Minimal travel is required. Must be able to drive an automobile and have valid operator license. Specific vision abilities required by this job include 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 $82,9000 and $138,0500.

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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