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AAA-The Auto Club Group · 1 month ago

Senior Litigation Casualty Claim Specialist - Michigan PIP

Hybrid - MI

Full-time

Hybrid

Mid, Senior Level

$75K/yr - $100K/yr

5+ years exp

AAA The Auto Club Group is seeking a 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 role, you will be responsible for reviewing claims, conducting investigations, and ensuring that policyholder benefits are identified and maximized.

Insurance

Responsibilities

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

Qualification

Negotiation of complex claimsAdvanced technical knowledgeLitigationSubrogation proceduresMedical terminologyCustomer service skillsEffective communicationProblem-solving skillsTime managementOrganizational skills

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

Five years of experience in the following: Negotiation of complex 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

Advanced technical knowledge of Essential Insurance Act (Michigan), Fair Trade Practices Act as it relates to claims, Subrogation procedures and processes, Intercompany arbitration, Litigation

Advanced technical 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

Ability to follow and apply ACG Claim policies, procedures and guidelines

Ability to work within assigned ACG Claim systems including basic PC software

Ability to perform claim file review and investigations

Ability to demonstrate effective communication skills (verbal and written)

Ability to demonstrate customer service skills by building and maintaining relationships with insureds/claimants while exhibiting understanding of their problems and responding to questions and concerns

Ability to analyze and solve problems while demonstrating sound decision making skills

Ability to prioritize claim related functions

Ability to process time sensitive data and information from multiple sources

Ability to manage time, organize and plan workload and responsibilities

Ability to attend virtual meetings and corporate/court onsite meetings