Sr. Claim Specialist (Medical Management Unit)

AAA-The Auto Club Group

14d • Remote

About The Position

Sr. Claim Specialist (Medical Management Unit) – The Auto Club Group What you will do: 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: 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 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 Claims Specialists 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, guardians, conservators, attorneys, treatment teams and case managers 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
• 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 or equivalent training in the following:
• Negotiation of complex Michigan 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
• Advance knowledge of: Essential Insurance Act (Michigan)
• Fair Trade Practices Act as it relates to claims
• Subrogation procedures and processes
• Intercompany arbitration
• Litigation
• Advance knowledge of: Negligence Law
• No-Fault Law
• Medical terminology and human anatomy
• MCCA and 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 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 workload and responsibilities
• Research, analyze, and interpret subrogation laws in various states

Nice To Haves

• 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

Responsibilities

• 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 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.
• Work with insureds, guardians, conservators, attorneys, treatment teams and case managers to obtain necessary information to complete the claims review process and make the appropriate determinations.

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, rewards, and much more

What This Job Offers

• Job Type: Full-time
• Career Level: Mid Level
• Education Level: No Education Listed