Senior Claims Representative - Legal

Blue Cross Blue Shield of Michigan•Lansing, MI

About The Position

Primary responsibilities of a Litigation Specialist/Senior Claims Representative – Legal handling construction defect claims includes, but is not limited to coverage analysis, collaboration with internal and external resources, management of outside counsel and resolution of claims in the best interest of our insureds. ESSENTIAL DUTIES AND RESPONSIBILITIES include the following. Other duties may be assigned. Handle suits on third party litigated claim files, including collaborating with and managing outside counsel and complex litigated claims files as assigned. Analyze coverage issues on litigated claim files and claim files with potential for litigation. Assist with negotiations, mediations, arbitrations, and settlement procedures as assigned. Attend and provide litigation advice in claim review meetings. Coordinate referral with AVP of Claims or VP of Claims on other litigated claims requests to outside counsel. Conduct legal research as necessary on pending suit files and as requested by other departments. Conduct audits of litigated claims files. Review company policy forms as needed. Research and write brief opinions on legal issues. Recommend reserve and payment changes as necessary for the file. Provide and report claims information to Senior Management on an as needed basis. Assist Forms Committee; propose changes/revisions/amendments to company policy forms, make appropriate policy language recommendations and draft policy language for new forms. Other duties as assigned by General Counsel, Sr. Claims Management, or Executive Management. Perform other specific duties and projects as assigned.

Requirements

Bachelor Degree from a 4-year college or university.
Juris Doctor degree
Minimum of 5 years' experience adjusting commercial claims for an insurance carrier or an attorney experienced in litigating or handling insurance claims.
Excellent oral and written communication skills.
Excellent presentation and facilitation skills.
Ability to make competent, independent decisions.
Ability to analyze coverage submissions and provide assistance.
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 handled 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 10 pounds

Nice To Haves

Admission to the state bar preferred
Relevant combination of education and experience may be considered in lieu of degree.

Responsibilities

Handle suits on third party litigated claim files, including collaborating with and managing outside counsel and complex litigated claims files as assigned.
Analyze coverage issues on litigated claim files and claim files with potential for litigation.
Assist with negotiations, mediations, arbitrations, and settlement procedures as assigned.
Attend and provide litigation advice in claim review meetings.
Coordinate referral with AVP of Claims or VP of Claims on other litigated claims requests to outside counsel.
Conduct legal research as necessary on pending suit files and as requested by other departments.
Conduct audits of litigated claims files.
Review company policy forms as needed.
Research and write brief opinions on legal issues.
Recommend reserve and payment changes as necessary for the file.
Provide and report claims information to Senior Management on an as needed basis.
Assist Forms Committee; propose changes/revisions/amendments to company policy forms, make appropriate policy language recommendations and draft policy language for new forms.
Perform other specific duties and projects as assigned.