Apply on Employer Site

AAA-The Auto Club Group · 3 days ago

Casualty Claim Specialist – Michigan PIP

Michigan, United States

Full-time

Hybrid

Mid Level

$66K/yr - $75K/yr

3+ years exp

AAA The Auto Club Group is seeking a Casualty Claim Specialist for their Michigan PIP unit. The role involves handling complex claims, conducting thorough investigations, and ensuring policyholder benefits are identified while working with various stakeholders to resolve claims effectively.

Insurance

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 complex coverage analysis

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

Qualification

Claim handlingNegotiation of claim settlementsSubrogation claimsMichigan No-Fault LawMedical terminologyAdjuster's licenseCustomer serviceEffective communicationProblem-solvingTime management

Required

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

Three years of experience or equivalent training in the following: Negotiation of claim settlements, Securing and evaluating evidence, Preparing manual and electronic estimates, Subrogation claims, Resolving 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, Handling simple 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