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AAA-The Auto Club Group · 1 day ago

Senior Claim Specialist-MI

Home, MI

Full-time

Hybrid

Mid, Senior Level

$80K/yr - $97K/yr

5+ years exp

AAA The Auto Club Group is seeking a Senior Claim Specialist to work under less supervision with a high level of authority. In this role, you will review assigned claims, conduct investigations, and ensure all possible policyholder benefits are identified while managing complex claims involving liability disputes and bodily injuries.

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

Handle the most complex claims involving liability disputes, bodily injuries, and coverage questions

Qualification

Negotiation of complex claimsAdvanced technical knowledgeInsurance knowledgeCPCU courseworkAdjuster’s license eligibilityCustomer service skillsEffective communicationTeamwork orientationCritical thinking

Required

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

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

Essential Insurance Act (Michigan)

Fair Trade Practices Act as it relates to claims

Subrogation procedures and processes

Intercompany arbitration

Litigation

Strong negotiation skills

A good teamwork orientation

Advanced technical knowledge of: Negligence Law, No-Fault Law, Medical terminology and human anatomy, 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 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 critical thinking and decision-making skills

Prioritize claim related functions

Process time sensitive data and information from multiple sources

Manage time, organize and plan workload and responsibilities

Attend virtual meetings and corporate/court onsite meetings

Work evenings or weekends

Must Reside in the State of Michigan