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Blue Cross Blue Shield of MichiganBM

Senior Claim Representative I - CA

Blue Cross Blue Shield of Michigan is the largest health insurer in Michigan, serving 4.3 million members with accessible and innovative health care solutions.

Blue Cross Blue Shield of Michigan

Employee count: 5000+

Salary: 81k-136k USD

United States only

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This position serves as a technical expert in the claim handler career path. Under limited supervision, handles claims with litigation, complex/catastrophic and/or coverage elements. Handles the most unique cases, where little precedence has been established. May handle the most complex, high touch or labor-intensive customers. Serves as a department leader by developing other employees and may function as acting manager in the absence of department management.

  • Independently administers complex claims and catastrophic exposures within authority, including claims from dedicated large accounts.
  • Establishes timely and appropriate reserves based on claim profile and anticipated financial exposure.
  • Represents the Company by working closely with customers, agents and brokers to resolve the most complex claim issues.
  • Negotiates settlements with attorneys or injured and exercises independent judgment to settle cases prior to mediation or litigation.
  • 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 relevant statutes and case law.
  • Actively participates in agent/client relationship management.
  • Mentors team members.
  • May serve as department leader in the absence of management or act as manager designee.

EDUCATION

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

EXPERIENCE

  • Seven years of progressively more responsible experience in a claims environment that provides the necessary skills, knowledge and abilities. Experience handling claims in multiple jurisdictions preferred. Bilingual skills preferred. A concentration in commercial trucking would be preferred; OR Two years of AF Group Claims Representative III experience that includes independent handling of the most complex claims and/or the most complex, high touch or labor-intensive customers.

QUALIFICATIONS

  • Ability and proficiency in the use of computers and company standard software specific to position.
  • Effective oral and written communication skills.
  • Effective customer service skills.
  • Ability to negotiate, build consensus and resolve conflict.
  • Ability to act as a representative of the Company and establish effective working relationships.
  • Ability to manage multiple priorities and meet established deadlines.
  • Attention to detail and analytical skills.
  • Ability to make independent decisions.
  • Ability to solve highly complex problems.
  • Ability to train and mentor others.
  • Ability to lead others.

COMPENSATION

“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 $80,960 and $135,520.”

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.

#CWU

About the job

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Posted on

Job type

Full Time

Experience level

Salary

Salary: 81k-136k USD

Education

Bachelor degree

Experience

2 years minimum

Experience accepted in place of education

Location requirements

Hiring timezones

United States +/- 0 hours

About Blue Cross Blue Shield of Michigan

Learn more about Blue Cross Blue Shield of Michigan and their company culture.

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Through groundbreaking technology, we are revolutionizing health care at Blue Cross Blue Shield of Michigan. Founded in 1939, we are proud to be the largest nonprofit health insurer in Michigan and serve over 4.3 million members across the state and nation. Our mission is clear: we are dedicated to providing affordable, innovative products that enhance the health and well-being of our members. With a network of over 35,000 health care providers, we ensure our members have access to quality health care coverage when they need it most.

BCBSM strives to improve health outcomes through partnerships with local communities and health organizations. Our Building Healthy Communities program has positively impacted over 500,000 students in schools across Michigan. Additionally, our Strengthening the Safety Net initiative has contributed over $18 million to support health clinics that serve low-income populations. We believe that everyone deserves access to quality health care, which is why we focus on advancing health equity and reducing health disparities.

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Blue Cross Blue Shield of Michigan

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