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Job Type:
Full time
Exempt/Non Exempt:
Salary
Job Description:
I. Position Description
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. Will earn a competitive salary of $62,281 $76,000 annually with annual bonus potential based on performance.
***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.***
Work under minimal supervision with a high-level approval authority to handle complex technical issues and complex claims.
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 process, and initiating documentation in the claim handling system. Complete complex coverage analysis. 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.
Claim Specialist assigned to the Liability, Bodily Injury, Med Pay, MRTS and Non-MI PIP claim units will handle highly complex claims involving liability disputes, bodily injuries, and valued up to $300,000. 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. May assist Claim Manager with file reviews and training.
II. 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.
Must have a valid State Driver's License
Experience:
Three years 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:
Advanced knowledge of:
Essential Insurance Act (Michigan)
Fair Trade Practices Act as it relates to claims
subrogation procedures and processes
intercompany arbitration
handling simple litigation
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 guidelines
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 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 information from multiple sources
manage time, organize and plan work load and responsibilities
safely operate a motor vehicle in order to visit repair facilities, homes (for inspections), patients, etc.
research analyze and interpret subrogation laws in various states
travel outside of assigned territory which may involve overnight stay
relocate, work evenings or weekends
III. 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
IV. Work Environment
Important Note: THE... 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.
