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Job Type:
Full time
Exempt/Non Exempt:
Salary
Job Description:
Sr Claim Specialist - Medical Management Unit- The Auto Club Group
What you will do:
The Auto Club Group is seeking prospectiveSeniorClaim Specialistswho canwork under less supervision with a high-level of authority to handle highly complex technical issues and the most complex claims.
In this position, you will have the opportunity to:
* Review assigned claims, contact the insured and other affected parties, set expectations for the remainder of the claim process, and initiate documentation in the claim handling system.
* Complete coverage analysis on the most complex claims.
* Ensure all possible policyholder benefits are identified.
* Create additional sub-claims if needed.
* Complete an investigation of the facts regarding the claim to further and in more detail determine if the claim should be paid, the applicable limits or exclusions and possible recovery potential.
* Conduct thorough reviews of damages and determine the applicability of state law and other factors related to the claim.
* Evaluate the financial value of the loss.
* Approve payments for the appropriate parties accordingly.
* Refer claims to other company units when necessary (e.g., Underwriting, Recovery Units or Claims Special Investigation Unit).
* Thoroughly document and/or code the claim file and complete all claim closure and related activities in the assigned claims management system.
* Utilize strong negotiating skills.
Senior Claims Specialists assigned to the PIP unit are responsible for claims involving the MCCA or quadriplegic, traumatic brain, amputations and other catastrophic injuries. The role will require proficiency in dealing with the MCCA and attorney represented claims. Work with insureds, physicians' offices and medical insurance carriers to obtain necessary information to complete the claims review process and make the appropriate determinations.
Work Environment
This position is currently able to work remotely from a home office location for day-to-day operations unless occasional travel for meetings, collaborative activities, or team building activities is specified by leadership. This is subject to change based on amendments and/or modifications to the ACG Flex Work policy.
With our powerful brand and the mentoring we offer, you will find your position as aSeniorClaim Specialistcan lead to a rewarding career at our growing organization.
How you will benefit:
Senior Claim Specialists will earn a competitive salary of $75,000 to $90,000 annually with annual bonus potential based on performance.
Excellent and comprehensive benefits packages are just another reason to work for the Auto Club Group. Benefits include:
o401k Match
oMedical
oDental
oVision
oPTO
oPaid Holidays
oTuition Reimbursement
We're looking for candidates who:
Preferred Qualifications
Education:
* Associate degree in Business Administration, Insurance or a related field or the equivalent in related work experience
* Completion of the Insurance Institute of America's: General Insurance Program, Associate in Claims, Associate in Management or equivalent
* CPCU coursework or designation
Required Qualifications (these are the minimum requirements to qualify):
Education:
* Complete ACG Claim Representative Training Program or demonstrate equivalent knowledge or experience
* In states where an Adjuster's license is required, the candidate must be eligible to acquire a State Adjuster's license within 90 days of hire and maintain as specified for appropriate states.
* Must have a valid State Driver's License
Experience:
Five years of experience in the following:
* Negotiation of complex Michigan claim settlements
* Securing and evaluating evidence
* Preparing manual and electronic estimates
* Subrogation claims
* Resolving complex coverage questions
* Taking statements
* Establishing clear evaluation and resolution plans for claims
Knowledge and Skills:
Advanced technical knowledge of
* Essential Insurance Act (Michigan)
* Fair Trade Practices Act as it relates to claims
* Subrogation procedures and processes
* Intercompany arbitration
* Litigation
Advanced technical knowledge of:
* Negligence Law
* No-Fault Law
* Medical terminology and human anatomy
* MCCA and attorney represented claims
Ability to:
* Handle claims to the line Claim Handling Standards
* Follow and apply ACG Claim policies, procedures and guidelines
* Work within assigned ACG Claim systems including basic PC software
* Perform claim file review and investigations
* Demonstrate effective communication skills (verbal and written)
* Demonstrate customer service skills by building and maintaining relationships with insureds/claimants while exhibiting understanding of their problems and responding to questions and concerns
* Analyze and solve problems while demonstrating sound decision making skills
* Prioritize claim related functions
* Process time sensitive data and... For full info follow application link.
As an equal opportunity employer, ACG is committed to providing equal opportunity in all employment practices,
including but not limited to: selection, hiring, assignment, re-assignment, promotion, transfer, compensation,
evaluation, benefits, training and development, discipline and termination. The company prohibits discrimination,
harassment, and retaliation in employment based on race, color, religion, national origin, gender, sexual
preference/orientation, marital status, pregnancy, childbirth or related medical conditions, age, disability or
handicap, citizenship status, service member status, genetic information, or any other category protected by
federal, state, or local law. Violation of this policy may result in disciplinary action including termination of
employment.
