Sr. Subrogation Claim Representative II - REMOTE
Blue Cross Blue Shield of Michigan
6d ago
0$83k - $138kOtherUnited Stateshimalayas
Claims-RepresentativeClaims-AdjusterWorkers-Compensation-Claims-AdjusterInsurance-Claims-SpecialistSubrogation-SpecialistRemote-Subrogation-SpecialistSubrogation-Claims-SpecialistSenior
Job Description
SUMMARYThis position serves as technical expert in the subrogation claim representative career path. Under limited supervision, manages subrogation worker’s compensation claims with litigation, complex/catastrophic and/or coverage elements. Manages unique cases, where sometimes little precedence has been established. Serves as department leader by developing other employees and may function as acting manager in the absence of department management. We are seeking an experienced workers’ compensation subrogation adjuster or bodily injury liability claims adjuster with a background in complex and litigated claims and negotiating settlements directly with personal injury attorneys and adverse carriers. Workers’ compensation subrogation experience is preferred; however, we will consider strong bodily injury candidates who have handled larger, litigated losses and are interested in transitioning those skills to subrogation.This role identifies, investigates, evaluates, and pursues recovery opportunities and develops strategies to maximize recoveries. Candidates must independently analyze complex claim issues and understand, interpret, and apply statutes and case law to develop claim strategy and negotiate resolutions. Multi-state and multi-line experience is preferred.This is a remote position requiring travel for team meetings 1–2 times per year and occasional in-person mediations.ESSENTIAL DUTIES AND RESPONSIBILITIES
Independently investigates, analyzes, determines potential liability, and effectively settles with adverse parties.
Recommends, plans and advocates a position on complex worker’s compensation subrogation claims.
Develops and manages complex subrogation claim action plans to resolution, coordinates claim processes and approves claim payments.
Supports the team by acting as back-up to other subrogation team members and manager and is manager’s or director’s proxy when necessary.
Updates databases and prepares reports utilizing standard software.
Proactively communicates and collaborates with workers’ compensation claims handlers.
Negotiates and settles claims within authority, at the earliest possible point to bring cases to final disposition.
Exercises independent judgment to settle cases prior to mediation and/or litigation.
Obtains all necessary documentation from the appropriate parties within established timelines.
Properly assesses the cause of action, collectible damages, and liability and expense exposures.
Composes correspondence and various reports in the management of subrogation claims.
Remains abreast of new case law and statutes affecting subrogation.
Maintains confidentiality of information processed.
Mentor team members on complex files and files above their authority.
Works with Claims in participating in agent/client relationship management.
Manages the administration of complex claims and catastrophic exposures, within authority, including claims generated from dedicated large accounts.
Assists in the development of reporting, analysis and conducts education & training programs as it relates to subrogation.
Represents the subrogation team on various committees and projects.
Directs claims administration efforts within statutory, procedural, case law, contractual and/or philosophical guidelines.
Provides leadership regarding case law understanding for subrogation team.
Provides guidance and advice when required or necessary and encourage/motivate employees in their daily efforts.
Serves as a technical expert for the subrogation team.
Coordinates special projects on behalf of management, as assigned.
Provides training sessions for team and/or other business units, as required.
Additional Responsibilities for SENIOR SUBROGATION CLAIM REPRESENTATIVE II:
Leads catastrophic subrogation claims with large claim volume.
Handles the most unique cases, where little precedence has been established, requiring innovative administration and problem resolution.
May provide oversight to vendors.
May take lead role in claim projects or initiatives.
Conducts audits of claim files.
Acts as liaison to claim consultants as needed to support enterprise initiatives.
EDUCATION AND EXPERIENCE
Relevant combination of education and experience may be considered in lieu of degree.
Bachelor’sdegree in insurance, business or a related field.
Continuous learning, as defined by the Company’s learning philosophy, is required.
Certification or progress toward certification is highly preferred and encouraged.
Senior Subrogation Claim Representative II:
Ten (10) years of progressively more responsible experience in a workers’ compensation subrogation or subrogation claims environment with demonstrated knowledge of subrogation, or in a claims environment handling liability claims, that provides the necessary skills, knowledge and abilities, such as experience in reviewing, investigating and closing the most complex workers’ compensation subrogation claims.
Experience handling claims in multiple jurisdictions re
