Sr. Claim Specialist (Medical Management Unit)
The Auto Club Group, Detroit, MI, United States
Sr. Claim Specialist (Medical Management Unit) The Auto Club Group
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.
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 $76,700 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)
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
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
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.
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 $76,700 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)
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
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