Claim Specialist

Job Type:

Job Description:

Reports to (job title):

Claim Manager as appropriate

Position Description

Post for All Units:

Work under minimal supervision with a high-level approval authority to handle complex technical issues and complex claims. 

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.

Additional Items to Post for Auto Physical Damage (“APD”) Unit Only:

Employees assigned to Auto Physical Damage (“APD”) claim unit will handle complex claims involving settling Total Losses, inspecting vehicles and preparing estimates of damage.  If in the DRS Examiner role, manage Direct Repair Shops for compliance with our program. Additional responsibilities may include the following:  determining cause of damage, establishing liability, and identifying subrogation potential.  Monitor repairs and approve car rental expense.  Oversee APD Litigation cases.  Manage the litigation process including attorney and budget management, participation in mediation activities and determining the appropriate settlement position. May assist Claim Manager with file reviews and training.

Additional Items to Post for Liability/Bodily Injury/Med Pay/MRTS/Non-MI PIP Only:

Claim Specialist assigned to the Liability, Bodily Injury, Med Pay, MRTS and Non-MI PIP claim units will handle highly complex claims involving liability disputes, bodily injuries, and valued up to $300,000.  Answer coverage and policy questions.  Handle Med Pay claims in all states, and PIP claims in KY, MN and ND.  Apply the correct liability determination, evaluate the damages and arrive at a fair settlement.  May assist Claim Manager with file reviews and training.

Additional Items to Post Michigan Personal Injury Protection (“PIP”) Units Only:

Claim Specialists assigned to the PIP unit are responsible for Michigan PIP intermediate claims involving: fractures, mild closed head injuries, surgical procedures, and claims involving attendant care.  The role will require proficiency in dealing with the MCCA and attorney represented claims. May handle losses beyond those identified previously. Work with insureds, physicians’ offices and medical insurance carriers to obtain necessary information to complete the claims review process and make the appropriate determinations.

Additional Items to Post for Homeowners and Homeowners CAT Units Only:

Claim Specialists assigned to Homeowner/CAT claim unit handle claims valued over $25,000 (for the inside desk role) and over $100,000 (for field role). Investigate claims requiring in-depth coverage analysis.  When handling claims in the field, must prepare damage estimates using claims software.  Review estimates for accuracy.   May monitor contractor repair status.   May assist Claim Manager with file reviews and training.

Additional Items to Post for Recovery Unit Only:

Claim Specialists assigned to a Recovery unit will complete complex recovery tasks on  claims for all lines of business determining the most cost effective approach for recovering money from responsible parties.  Manage the litigation process including attorney and budget management, participation in mediation activities and determining the appropriate settlement position.  Act as a resource or mentor for the lines of business and others within the Recovery Unit by providing guidance and coaching on investigation, preservation of evidence, proper notice and various claim handling tasks.

Required Qualifications (these are the minimum requirements to qualify)

Education (include minimum education and any licensing/certifications):

Post for All Claim Units:

• 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.

Additional Items to Post for Subrogation Only:

Education

• Must attain all required State Adjuster licenses for applicable states within 60 days after completing licensing coursework

Experience:

Post for All Claim Units:

• 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

Knowledge and Skills:

Post for All Claim Units:

Advanced knowledge of:

• Essential Insurance Act (Michigan)

• Fair Trade Practices Act as it relates to claims

• subrogation procedures and processes

• intercompany arbitration

• handling simple litigation

Additional Items to Post for Auto Physical Damage (“APD”) Units Only:

Advanced knowledge of:

• Negligence Law

• No-Fault Law

• collision repair techniques

Additional Items to Post for Liability, Bodily Injury, Med Pay, MRTS and Non-MI Personal Injury Protection (“PIP”) Units Only:

Advanced knowledge of:

• Negligence Law

• No-Fault Law

• medical terminology and human anatomy

Additional Items to Post MI Personal Injury Protection (“PIP”) Units Only:

Advanced knowledge of:

• Negligence Law

• No-Fault Law

• medical terminology and human anatomy

• MCCA and attorney represented claims

Additional Items to Post for Homeowners and Homeowners CAT Units Only:

• advanced knowledge of building construction and repair techniques

Ability to:

Post for All Claim Units:

• 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 work load and responsibilities

• safely operate a motor vehicle in order to visit repair facilities, homes (for inspections), patients, etc.

• research analyze and interpret subrogation laws in various states

• travel outside of assigned territory which may involve overnight stay

• relocate, work evenings or weekends

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

• I-Car ProLevel training

• CCC training

• Xactware Training

Post for Homeowners/CAT Units Only:

Ability to:

• lift up to 25 pounds

• climb ladders

• walk on roofs

Work Environment

May work in a temperature controlled office environment or a remote/virtual setting.  Depending on line travel may be required to various repair facilities in order to conduct inspections/re-inspections, visit patients, hospitals, attorneys, rehabilitation centers, repair facilities, etc. per with exposure to road hazards and temperature extremes. For Homeowners and CAT may require deployment to territories impacted by storms.

Important Note: 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. 

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.