Senior Litigation Casualty Claim Specialist - Michigan PIP

AAA-The Auto Club Group

100d • $74,900 - $99,800

About The Position

The Auto Club Group is seeking prospective Senior Claim Specialist who can work 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 Claim Specialist 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. 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

• Complete ACG Claim Representative Training Program or demonstrate equivalent knowledge or experience.
• 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 involve conducting in-person inspections or frequent in-person meetings.
• Five years of experience in negotiation of complex claim settlements, securing and evaluating evidence, preparing manual and electronic estimates, subrogation claims, resolving complex coverage questions, taking statements, and establishing clear evaluation and resolution plans for claims.
• Advanced technical knowledge of Essential Insurance Act (Michigan), Fair Trade Practices Act as it relates to claims, subrogation procedures and processes, intercompany arbitration, litigation, negligence law, no-fault law, medical terminology and human anatomy, MCCA and attorney represented claims.

Nice To Haves

• Associate degree in Business Administration, Insurance or a related field or 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.

Responsibilities

• Review assigned claims and 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.
• Conduct thorough investigations of the facts regarding the claim.
• Determine if the claim should be paid, 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.
• Document and/or code the claim file and complete all claim closure and related activities.
• Utilize strong negotiating skills.

Benefits

• 401k Match
• Medical
• Dental
• Vision
• PTO
• Paid Holidays
• Tuition Reimbursement

What This Job Offers

• Job Type: Full-time
• Career Level: Mid Level
• Education Level: Bachelor's degree
• Number of Employees: 101-250 employees