Claim Representative I
The Auto Club Group (ACG) provides membership, travel, insurance and financial services offerings to approximately 9 million members and customers across 11 states and 2 U.S. territories through the AAA, Meemic and Fremont brands. ACG belongs to the national AAA federation and is the second largest AAA club in North America.
Primary Duties and Responsibilities (details of the basic job functions):
Handle basic, entry-level claims under close supervision and with a lower-level of claim-handling authority. Claim handling responsibilities may cover most of the lifecycle of the claim, or focus on an expanded role with specific phases such as subrogation.
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, and initiating documentation in the claim handling system. Complete a general coverage analysis including a review of policy coverages and provisions, and the applicability to the reported loss. Ensure all possible policyholder benefits are identified, create additional sub-claims if needed or refer complex claims to management or the appropriate claim handler. 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. Make referrals 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.
Additional Items to Post for Auto Physical Damage ("APD") Units Only:
Employees assigned to Auto Physical Damage ("APD") claims unit will handle simple claims that do not involve injuries or third party liability and utilize the company's Direct Repair Shop (DRS) and QCS/Desk Review or Accelerate programs. Utilizing these programs require a basic level of claims handling expertise and authority. Additional responsibilities may include the following: determining liability issues, injuries or other factors require reassignment of the claim; contacting the insured to verify and gather accident and damage facts to determine the appropriate method of inspecting the vehicle; reviewing vehicle repair estimates to understand the value of damages applicable to the claim; monitoring and approving car rental expenses; obtaining and reviewing police reports and other vehicle or accident related documents as part of the claim investigation; monitoring vehicle repair status and interacting with DRS shops and Claims DRS Examiners when needed to resolve and communicate claim status and issues.
Additional Items to Post for Homeowners and Homeowners CAT Units Only:
Employees assigned to Homeowner claims unit will handle simple claims generally valued less than $5,000, not requiring coverage analysis or disputes and utilizing ACG direct repair contractor programs. Utilizing these programs require a basic level of claims handling expertise and authority. Additional responsibilities may include the following: providing emergency funds and arranging for alternate living expenses if necessary; working with the insured to coordinate selection and assignment of an approved contractor; monitoring contractor repair status and communicating and resolving issues with the insured.
Additional Items to Post for Recovery Units Only:
Employees assigned to the Recovery unit will complete recovery tasks on simple claims, such as auto collision, home or PIP/med pay assignments associated with the collection process. The tasks may not cover the entire lifecycle of a claim but will be an expansion of those aspects related to the financial recovery of funds previously paid on a claim from liable parties or other insurance carriers. Additional responsibilities may include the following: identifying liable parties and determining insurance status; referring files to collection agencies including preparing associated proofs; answering inquiry calls and gathering additional proofs or completing investigations when necessary; obtaining information from claim-related systems; working with collection vendors to approve requests to file suit; completing the receipt and file closure process ensuring that funds are returned and accounted for appropriately; reimbursing deductibles and preparing mini tort proofs when applicable.
Supervisory Responsibilities (briefly describe, if applicable, or indicate None):
- 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 2000 training
- CCC training
- Xactware Training
Works in a temperature controlled office environment.
Required Qualifications (these are the minimum requirements to qualify)
Education (include minimum education and any licensing/certifications):
- 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.
- Must have a valid State Driver's License
- Six months of experience with:
- Negotiating claim settlements
- Securing and evaluating evidence
- Preparing manual and electronic estimates
- Subrogation claims
Knowledge and Skills:
- Basic knowledge of:
- Essential Insurance Act (Michigan)
- Fair Trade Practices Act as it relates to claims
- Subrogation procedures and processes
- Intercompany arbitration
Additional Items to Post for APD Units Only:
Basic knowledge of:
- Negligence Law
- No-Fault Law
- Collision repair and techniques
Additional Items to Post for Homeowners and Homeowners CAT Units Only:
- Basic knowledge of basic construction and repair techniques.
- 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
- Research analyze and interpret subrogation laws in various states
- Travel outside of assigned territory which may involve overnight stay
- Relocate, work evenings or weekends
The Auto Club Group offers a competitive compensation and benefits package including a base salary with performance based incentives; medical/dental/vision insurance, pension, 401(k), generous time off, a complimentary AAA Membership and much more!
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.
The Auto Club Group, and all of its affiliated companies, is an equal opportunity/affirmative action 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.
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