Michigan Claim Customer Service Representative

AAA-The Auto Club Group • Detroit, MI

4d • $19 - $22 • Remote

About The Position

Claim Customer Service Representatives will be responsible for taking first notice of loss, handling claim inquiries, initiating claim services, and handling low-complexity, one-touch claims in a call center environment. Identifies non-complex claims for one-touch claim adjudication upon intake. Determines the type and extent of loss and ensures the claim is consistent with all reported facts. Reviews necessary legal and police/fire reports to process claims as necessary. Interprets policy language and applies coverage to authorize or deny claims. Initiates services, authorizes, and resolves issues related to services such as car rental and vehicle repairs and non-complex homeowner claims (e.g. food spoilage). Initiates and creates payments, settles or recommends settlement value of claims within specified limits. Identifies additional claim exposures and creates sub-claims as necessary. Refers files for investigation as warranted. Informs insured of coverage decision on claims within defined scope. Responds to claimant inquiries and explains payments. Reviews the status of open and closed reserves and adjusts consistent with exposures. Identify claims for salvage and subrogation potential in accordance to company policy. Ensure compliance with state regulations. Completes first notice of loss for all policy products and handles inbound claim inquiries received via phone, the ACG website and other sources. Explains the benefits of company programs to customers, and initiate services, such as arranging for repair inspections, vehicle tows and car rental. Provides basic information to members regarding claims procedures in accordance with Customer Interaction Model. Promotes customer satisfaction and provides seamless service to ensure customer service goals and standards are met. Navigates through various sources of information and claim processing systems (E.g., FACTS, CPS, Point of Sale, IPM insurance systems, Intranet/Internet, manuals and call center models). Responds to members/customers questions in a timely manner.

Requirements

• High School Diploma or equivalent
• Completion of AAA approved call center training program, appropriate level ACG Claim Representative Training program and ongoing training and certification for the position
• Must be eligible to acquire and maintain a state adjuster’s license for appropriate state(s)
• Processing FNOL information and handling claim inquiries utilizing PCs and software packages (e.g. ACG claim systems, Microsoft Word, Excel)
• Reading and comprehending various Customer Care service tools (manuals, work models, etc.)
• Performing mathematical calculations including adding, subtracting, percentages, etc.
• Analyzing and resolving problems
• Knowledge of Claim processing policy and procedures
• Knowledge of General claim processing functions
• Knowledge of Claim processing systems
• Knowledge of Telephone etiquette
• Ability to provide a high level of customer service in a professional call center environment using the following skills:
• Strong interpersonal skills demonstrated through work experience, participation in extra-curricular activities and/or community involvement
• Strong communication skills required in understanding customers’ concerns and to provide high quality customer service as demonstrated through the effective use of the customer care call center model
• Effective listening skills
• Ability to learn and apply claim handling skills, including: Policy analysis and coverage application, Claim payment coding, issuance, and exception handling, Proactive customer contact and issue resolution, Car rental coverage knowledge, Claims’ related policies and procedures, Auto and home repair estimate basics and compliance review, State compliance requirements, Subrogation identification and referral (e.g. MI liability basics regarding uninsured motorists)
• Understand insurance fraud scenarios and recognize potential fraud indicators
• Issue written correspondence
• Prioritize claims-related functions
• Successfully complete at least one of the following within 9 months of hire: AAA general claim policy training. Policy, negligence and no-fault training
• Work independently
• Work under pressure
• Record and maintain information accurately and in a timely fashion
• Work effectively in a team environment
• Sit for the majority of the workday
• Willingness and ability to work irregular shifts, including weekends and holidays

Nice To Haves

• Associate’s degree in Business Administration or a related field, or the equivalent in related work experience
• Completion of (IIA) Insurance Institute of America or other insurance coursework
• Experience in a claim related field such as insurance, automotive, medical or legal services
• Experience in a call center environment
• Experience Utilizing ACG automated systems
• Experience Investigating and resolving claims related problems
• Experience Handling claims or claims support tasks such as processing glass claims, car rentals, invoice payments, etc.
• Knowledge of ACG insurance processes and procedures
• Knowledge of auto and home repair basics and cost estimating
• Knowledge of State insurance laws
• Knowledge of Regulatory compliance requirements
• Knowledge of Property and casualty insurance policy language and provisions
• Knowledge of Claims quality service standards
• Knowledge of Liability, negligence, No-Fault principles and subrogation

Responsibilities

• Taking first notice of loss
• Handling claim inquiries
• Initiating claim services
• Handling low-complexity, one-touch claims in a call center environment
• Identifies non-complex claims for one-touch claim adjudication upon intake
• Determines the type and extent of loss and ensures the claim is consistent with all reported facts
• Reviews necessary legal and police/fire reports to process claims as necessary
• Interprets policy language and applies coverage to authorize or deny claims
• Initiates services, authorizes, and resolves issues related to services such as car rental and vehicle repairs and non-complex homeowner claims (e.g. food spoilage)
• Initiates and creates payments, settles or recommends settlement value of claims within specified limits
• Identifies additional claim exposures and creates sub-claims as necessary
• Refers files for investigation as warranted
• Informs insured of coverage decision on claims within defined scope
• Responds to claimant inquiries and explains payments
• Reviews the status of open and closed reserves and adjusts consistent with exposures
• Identify claims for salvage and subrogation potential in accordance to company policy
• Ensure compliance with state regulations
• Completes first notice of loss for all policy products and handles inbound claim inquiries received via phone, the ACG website and other sources
• Explains the benefits of company programs to customers, and initiate services, such as arranging for repair inspections, vehicle tows and car rental
• Provides basic information to members regarding claims procedures in accordance with Customer Interaction Model
• Promotes customer satisfaction and provides seamless service to ensure customer service goals and standards are met
• Navigates through various sources of information and claim processing systems (E.g., FACTS, CPS, Point of Sale, IPM insurance systems, Intranet/Internet, manuals and call center models)
• Responds to members/customers questions in a timely manner

Benefits

• 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, and rewards

What This Job Offers

• Job Type: Full-time
• Career Level: Entry Level
• Education Level: High school or GED