Claim Representative II - Michigan

Blue Cross Blue Shield of Michigan • Lansing, MI

2d • Hybrid

About The Position

This is the intermediate level of the claim handler career path. Handles moderate to difficult claims. Exercises progressively more discretion in the determination of compensability of claims. Considers many factors in the determination claim reserves. Negotiates and settles claims within given authority. Works remotely with occasional travel to on-site visits with insured municipalities. Is a resident in the State of Michigan.

Requirements

• Bachelor’s degree in a related field. Relevant combination of education and experience may be considered in lieu of degree.
• Three years experience in property and casualty claims environment which provides the necessary skills, knowledge and abilities, such as experience in reviewing policy coverages and exclusions, drafting coverage letters, investigating and settling property and casualty losses, and adjusting claims through litigation and trial.
• Ability and proficiency in the use of computers and company standard software specific to position.
• Knowledge of medical and legal terminology related to the work.
• Knowledge of Michigan municipal liability.
• Knowledge of best practices for adjusting property losses.
• Effective oral and written communication skills.
• Effective customer service skills.
• Ability to negotiate, build consensus and resolve conflict.
• Ability to manage multiple priorities and meet established deadlines.
• Attention to detail and analytical skills.
• Ability to work independently as well as within a team.
• Ability to make independent decisions.
• Ability to solve complex problems.

Nice To Haves

• Experience handling claims in multiple jurisdictions preferred.
• Bilingual skills preferred.
• Certification or progress toward certification is highly preferred and encouraged.

Responsibilities

• Verifies coverage of claimed property and casualty damage.
• Determines liability for covered claims by thorough investigation of the claim and applicable exclusions.
• Analyzes liability for claims pursuant to Michigan municipal liability statutes and caselaw.
• Establishes timely and appropriate reserves based on the profile of the claim within given authority based on anticipated financial exposure.
• Documents specifics of claims with potential for subrogation recovery, including amount of potential recovery monies.
• Manages estimates and invoices for property, casualty and automobile claims, and approves payments based on support showing relationship to the cause of loss and legal liability for payment.
• Concludes and closes files following resolution of claims to meet internal performance standards while complying with state legislation to avoid penalties and manage expenses.
• Negotiates settlements with attorneys or injured parties within given authority at the earliest possible point to bring cases to final disposition.
• Works closely with manager on complex files or files above settlement/reserve authority.
• 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 municipal liability statutes and case law in order to accurately interpret and apply relevant laws.
• Administers complex claims and catastrophic exposures within authority, including claims from dedicated large accounts.
• Exercises independent judgment to settle cases prior to mediation or litigation.
• Actively participates in agent/client relationship management.
• Assists in mentoring team members.

Benefits

• Actual compensation decision relies on the consideration of internal equity, candidate’s skills and professional experience, geographic location, market, and other potential factors.

What This Job Offers

• Job Type: Full-time
• Career Level: Mid Level