Senior Claim Specialist (Medical Management Unit)

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Job Type : Full time

Exempt / Non Exempt :

Salary

Job Description :

Senior 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.

Work Environment

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.

How you will benefit :

A competitive annual salary between $80,000 to 90,000

ACG offers excellent and comprehensive benefits packages, including :

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

We're looking for candidates who :

Required Qualifications (these are the minimum requirements to qualify)

Education :

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.

Experience :

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

Knowledge and Skills :

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

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

CPCU coursework or designation

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Who We Are

Become a part of something bigger.

The Auto Club Group (ACG) provides membership, travel, insurance, and financial service offerings to approximately 14+ million members and customers across 14 states and 2 U.S. territories through AAA, Meemic, and Fremont brands. ACG belongs to the national AAA federation and is the second largest AAA club in North America.

By continuing to invest in more advanced technology, pursuing innovative products, and hiring a highly skilled workforce, AAA continues to build upon its heritage of providing quality service and helping our members enjoy life's journey through insurance, travel, financial services, and roadside assistance.

And when you join our team, one of the first things you'll notice is that same, whole-hearted, enthusiastic advocacy for each other.

We have positions available for every walk of life! AAA prides itself on creating an inclusive and welcoming environment of diverse backgrounds, experiences, and viewpoints, realizing our differences make us stronger.

To learn more about AAA The Auto Club Group visit www.aaa.com

Important Note :

ACG's Compensation philosophy is to provide a market-competitive structure of fair, equitable and performance-based pay to attract and retain excellent talent that will enable ACG to meet its short and long-term goals. ACG utilizes a geographic pay differential as part of the base salary compensation program. Pay ranges outlined in this posting are based on the various ranges within the geographic areas which ACG operates. Salary at time of offer is determined based on these and other factors as associated with the job and job level.

The above statements describe the principal and essential functions, but not all functions that may be inherent in the job. This job requires the ability to perform duties contained in the job description for this position, including, but not limited to, the above requirements. Reasonable accommodations will be made for otherwise qualified applicants, as needed, to enable them to fulfill these requirements.

The Auto Club Group, and all its affiliated companies, is an equal opportunity employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, gender identity, sexual orientation, national origin, disability or protected veteran status.

Regular and reliable attendance is essential for the function of this job.

AAA The Auto Club Group is committed to providing a safe workplace. Every applicant offered employment within The Auto Club Group will be required to consent to a background and drug screen based on the requirements of the position.