Senior Claim Representative - Legal

Blue Cross Blue Shield of Michigan•Lansing, MI

14d

About The Position

SUMMARY This Senior Claims Representative position is within the company’s complex claim handling unit. The primary responsibility of this position is the management and resolution of the company’s most complex commercial casualty claims with minimal supervision. Claims managed by this position are among the most complex received by the claims department and often present the highest and most severe potential exposure. Further primary responsibilities include handling negotiations on any and all claims assigned, understanding and verifying coverage policy provisions, limitations, deductibles, and exclusions, taking statements or interviews when necessary, from all parties, coordinating referral of coverage requests, and assigning losses to defense firms and/or independent adjusters as necessary. ESSENTIAL DUTIES AND RESPONSIBILITIES include the following: Other duties may be assigned.

Requirements

Bachelor’s degree from a 4-year college or university.
At least 5 years of experience managing large and/or complex commercial casualty claims and demonstrated knowledge and ability to do so at a high level of performance.
Excellent oral and written communication skills.
Excellent presentation and facilitation skills.
Ability to make competent, independent decisions.
Ability to analyze coverage submissions and help.
Ability to prioritize, organize and plan work for self and others.
Excellent customer service skills.
Superior problem-solving ability.
Thorough knowledge of claim procedures, policies, terminology, etc.
Computer proficient with Microsoft Office programs, such as Word, Excel, and Outlook.
Possess State adjusting license(s) as applicable.
Ensure assigned files are managed in good faith as defined by statute, case-law and Corporate standards.
Ability to travel as required.
Ability to interact professionally with others
Sit, stand/walk ambulatory
Ability to lift ten pounds

Nice To Haves

Juris Doctor degree (weighed favorably, but not a requirement)
Admission to the state bar preferred

Responsibilities

Promptly and efficiently adjust a caseload of the company’s most complex and volatile casualty claim files in accordance with company policies and procedures. This caseload will represent suits and third-party liability claims where successful collaboration with outside counsel is required.
Maintain an active diary and updated plan of action on 100% caseload files.
Adhere to assigned authority limits for reserving and payments (including settlements).
Exercise independent decision-making skills with minimal to moderate supervision and direction on claims assigned, using knowledge of local codes, standards, and law.
Evaluate coverage thoroughly for each claim received and work closely with internal counsel to ensure each coverage position taken is correct.
Investigate the facts of each claim, including obtaining key documentation such as police reports, medical reports, appraisals, estimates, photographs, etc. to evaluate claims in accordance with company standards. This may include traveling to observe key locations or discuss the case with insureds, attorneys, or key witnesses and experts.
Evaluate each claim’s value, recommend appropriate reserves, and ensure that reserves are maintained at appropriate levels as the claim develops.
Evaluate and make decisions regarding coverage, liability, and compensability.
Timely present cases to management and other relevant associates for the purpose of discussing strategy, setting reserves, and obtaining payment authority.
Negotiate settlements or deny payments where no coverage, liability, or compensability exists.
Attend mediations, settlement conferences, arbitrations, and trials when appropriate.
Identify and thoroughly investigate all recovery and subrogation opportunities for each claim.
Return all telephone calls within one (1) business day, when possible. All messages from customers and agents are to be returned by the end of the same business day on which the call was received. Report all service complaints to management immediately upon receipt.
Maintain personal compliance with all continuing education requirements as mandated by statute or by office policy.
Providing occasional training and mentoring for other members of the team as well as the claims department.
Adhere to the company’s code of ethics.
Perform related duties assigned.