Senior Claim Specialist - Bodily Injury Litigation

AAA-The Auto Club Group•MI-Admin Office Building (AOB), MI

2d•Hybrid

About The Position

This position requires you to reside in the State of Michigan, preferably within the Metro-Detroit Area. In this position you are currently able to work remotely from your home; for day-to-day operations, with occasional "TRAVEL" for meetings (mediation, depositions & more), collaborative activities, or team building activities specified by leadership. This is subject to change based on amendments and/or modifications to the ACG Flex Work policy. Senior Casualty Litigation Specialist (Michigan) – The Auto Club Group Reports to: Claim Manager II. The Auto Club Group is seeking a prospective Senior Claim Specialist to work under less supervision with a high-level of authority. 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 Claim Specialists assigned Liability/BI/Med Pay/Non-MI PIP claims involving litigation/arbitration. Handle the most complex claims involving liability disputes, bodily injuries, and coverage questions. With our powerful brand and the mentoring, we offer, you will find your position as a Senior Claim Specialist can lead to a rewarding career at our growing organization.

Requirements

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
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.
Five years of experience in the following: Negotiation of complex 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
Advanced technical knowledge Essential Insurance Act (Michigan) Fair Trade Practices Act as it relates to claims.
Subrogation procedures and processes
Intercompany arbitration
Litigation
Strong negotiation skills
A good teamwork orientation
Advanced technical knowledge of: Negligence Law
No-Fault Law
Medical terminology and human anatomy
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 critical thinking and decision-making skills
Prioritize claim related functions
Process time sensitive data and information from multiple sources
Manage time, organize and plan workload and responsibilities
Attend virtual meetings and corporate/court onsite meetings
Work evenings or weekends
Must Reside in the State of Michigan

Responsibilities

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.
Handle the most complex claims involving liability disputes, bodily injuries, and coverage questions.