It's a great time to join AAA The Auto Club Group!
JOIN THE TEAM COMMITTED TO DRIVING YOUR CAREER FORWARD
Job Type:
Full time
Exempt/Non Exempt:
Salary
Job Description:
Michigan Medicare Claim Representative II - The Auto Club Group
What will you do:The Auto Club Group is seeking prospective Claim Representative II who will work under normal supervision with an intermediate-level approval authority to handle moderately complex claims within Claim Handling Standards in the field or inside units. Resolve coverage questions, take statements and establish clear evaluation and resolution plans for claims.
In this position, you will have the opportunity to:
Claim handling responsibilities will include the following: reviewing assigned claims, contacting the insured and other affected parties, setting expectations for the remainder of the claim, and initiating documentation in the claim handling system.
Complete coverage analysis including a review of policy coverages and provisions, and the applicability to the reported loss.
Ensure all possible policyholder benefits are identified, create additional sub-claims if needed or refer complex claims to management or the appropriate claim handler.
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.
Employees assigned to the Liability, Bodily Injury, Med Pay, MRTS and Non-MI PIP claim units will handle moderately complex claims involving liability disputes, bodily injuries, and generally valued up to $50,000. Answer coverage and policy questions. Handle Med Pay claims in all states, and PIP claims in KY, MN and ND. Apply the correct liability determination, evaluate the damages and arrive at a fair settlement.
Supervisory Responsibilities (briefly describe, if applicable, or indicate None):
None
Work EnvironmentThis 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 aClaim Representative II can lead to a rewarding career at our growing organization.
How will you benefit:
A competitive annual salary between $64,100 to $83,300
ACG offers excellent and comprehensive benefits packages, including:
Medical, dental and vision benefits
401k Match
Paid parental leave and adoption assistance
Paid Time Off (PTO), company paid holidays, CEO days, and floating holidays
Paid volunteer day annually
Tuition assistance program, professional certification reimbursement program and other professional development opportunities
AAA Membership
Discounts, perks, rewards, and much more
We're looking for candidates who:Required Qualifications (these are the minimum requirements to qualify):Education (include minimum education and any licensing/certifications):
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.
A valid driver's license is required if the primary responsibilities of the role involve conducting in-person inspections or frequent in-person meetings with members.
Experience:One year of experience or equivalent training in the following:
Negotiation of claim settlements
Securing and evaluating evidence
Preparing manual and electronic estimates
Subrogation claims
Resolving coverage questions
Taking statements
Establishing clear evaluation and resolution plans for claims
Knowledge and Skills:Knowledge of:
Essential Insurance Act (Michigan)
Fair Trade Practices Act as it relates to claims
Subrogation procedures and processes
Intercompany arbitration
Advance knowledge of:
Negligence Law
No-Fault Law
Medical terminology and human anatomy
Ability to:
Handle claims to the line Claim Handling Standards
Follow and apply ACG Claim policies, procedures and guideline
Work within assigned ACG Claim systems including basic PC software
Perform basic claim file review and investigations
Demonstrate effective communication skills (verbal and written)
Demonstrate customer service skills by building and maintaining... 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.
