Senior Claim Representative I- (Handle CA jurisdiction)
Blue Cross Blue Shield of Michigan · US
This position serves as a technical expert in the claim handler career path. Under limited supervision, handles claims with litigation, complex/catastrophic...
Job description
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...