Claim Specialist - Generic
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):
Independently performs detailed and highly complex claim investigations/processing or those of a higher dollar value at both internal and off-site locations regarding the specialized field assigned. Examines policies to determine the status, extent, type of coverage and need for additional information. Obtains necessary accident, legal, expert opinion and police reports to complete files. Determines the type and extent of loss and ensures the claim is consistent with all reported facts. Determines validity of claim and prepares a written summary of findings. Conducts investigations, defines appropriate evidence and obtains supportive documentation. May determine extent of injuries and reserves, evaluate claims for long term exposure, prepare initial and bi-annual reserve projections for re-insurers, evaluate and maintain adequate reserves and advise re-insurers and finance of recommendations. Reviews assigned claim files on diary and checks for progress toward completion of settlements. Determines if there is a need for further investigation. Evaluates, negotiates, responds to inquiries and settles claims.
Provides guidance and technical support to staff members regarding specialized discipline. Participates in training claims personnel with respect to specific assigned disciplines. Assists in monitoring claims activity as it relates to expertise. Reviews the status of open and closed reserves and makes adjustments consistent with exposures. Conducts re-inspections as necessary. Performs duties characteristic of a Claim Representative and in addition assists manager in activities such as internal control reviews, special projects, external fraud investigations, and other related areas specific to claim operations.
Assists management in oversight activities of claims operations, such as internal control reviews, limited work product reviews, processing issues and related functions. Assists in the review of excess tolerance reports and check registers to ensure compliance with corporate policies and procedures. Summarizes and communicates results to management. Prepares and/or participates in the preparation of various performance reports in regards to specialized projects or programs within the assigned area.
Periodically reviews actual services rendered to ensure customers receive the type and quality of work authorized.
May participate in the Settlement Support Council and provide expertise regarding structured settlement candidates. Meets with branches/legal department to assist in structured settlement utilization/litigation as necessary. Works closely with and directs structured settlement companies (vendors) in negotiation/settlement process. Attends court hearings to assist in the approval process. Frequently acts in an advisory capacity. Responsible for production results in assigned geographical territory. Makes independent decisions regarding structured settlement potential on each case referred to the unit. Has skills/authority to accept or reject candidate for structured assignment.
Reviews files for potential subrogation and completes subrogation forms as needed. Assists in the recovery of corporate claim expenditures from insureds/applicants, uninsured motorists, businesses, other insurers, etc. in accordance with established procedures.
Performs other related duties as assigned.
Associate's degree in Business Administration, Insurance or a related field or equivalent work experience.
Completion of IIA (Insurance Institute of America) or other insurance coursework.
Subrogation experience in a property/casualty insurance company.
Property insurance industry business experience.
Strong negotiation and investigation skills.
- PenPro estimate writing programs
- Completion of one or more of AAA sponsored Auto Physical courses (i.e. Vale Tech, Motors Insurance Corporation/General Motors Institute)
- Lift up to 25 pounds
- Climb ladders
- Walk on roofs
Works in a temperature controlled office environment. Frequent (up to 60% of work time) exposure to road hazards and temperature extremes.
Required Qualifications (these are the minimum requirements to qualify):
Successful completion of basic Claim Representative Training Program or equivalent or ability to obtain within 9 months.
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.
Possession of a valid State driver's license.
Completion/possession of one or more of the following: *
- Claim Representative Training Program, including the Basic Building Damage School
- Successful completion of the NICB basic SIU Academy within the first year. Subsequent successful completion of the NICB advanced SIU Academy when scheduled
- Successful completion of the American Educational Institute, Inc. five course program resulting in a Fraud Claim Law Specialist within two years
- Possession of or ability to obtain a Builder's License within the first six months of employment in position
Extensive experience as a Claim Representative, a Public or Private Investigator or equivalent.
Experience in the investigation, evaluation and settlement of one or more of the following: *
- Auto no-fault claims including automobile market evaluations and the preparation of auto repair estimates
- Auto PIP/BI
- Homeowner medical and BI
- Boatowner medical and BI
- Homeowner property claims, including accurately preparing construction damage estimates and adjusting property damage
- Evaluating construction repairs for quality and compliance with repair estimates
- Inspecting and evaluating auto repairs for quality and compliance with estimates
- Inspecting and evaluating construction repairs for quality and compliance with repair estimates
- Subrogation claim handling
Knowledge of one or more of the following: *
- Company claim policies and procedures
- Negligence Law
- No-Fault Law in Michigan
- Essential Insurance Act as it pertains to claim handling
- The Fair Trade Practices Act as related to claims
- Criminal law
- Court procedures
- Homeowners' coverage
- Property provisions
- Concepts and principles of property claims
- Auto, Home policy and No-Fault statutes
- Fraud and arson indicators relative to auto property, home property and/or bodily injury claims
- Medical terminology, human anatomy, and/or billing codes and/or bio-mechanical principles
- Vehicle construction, identification, arson cause and origins and/or locking systems
- Building construction
- Third party collection practices
- Subrogation procedures
- Legal processing of subrogation claims
- Intercompany arbitration
Demonstrated skill in:
- Organization and planning
- Analyzing and problem solving
- Decision making
Ability to perform one or more of the following: *
- Communicate effectively with others in a work environment and with the public (e.g. police department, vendors, contractors, attorneys)
- Provide guidance and training to claims personnel in the resolution of claims
- Investigate claims, define appropriate evidence and obtain supportive documentation
- Estimate damage and determine settlement value of property damage claims
- Develop cost reduction and/or cost containment measures with respect to operating expenses and paid claims
- Evaluate, negotiate, respond to inquiries and settle claims
- Impart fraud awareness training in a formal or informal setting to other AAA employees, community groups or related professional organizations
- Function effectively and independently in a personal computer environment utilizing word processing, spreadsheet and external software systems
- Present effective and persuasive testimony in civil and criminal litigation on a regular basis
- Coordinate the repair of property at out-state locations
- Work irregular hours and respond to emergencies on a twenty-four per day basis to service customers
- Prepare and present activity and statistical reports
- Coordinate and control major projects
- Safely operate a motor vehicle in order to perform claim inspections/resolutions
- Research, analysis and interpretation of subrogation laws in various states
- Process complex, time sensitive data and information from various sources
- Make decisions based on data presented
- Complete multiple complex tasks in a timely fashion
Written communication skills. (A written sample may be required at time of interview).
May require over night or extended travel.
The Auto Club Group offers a competitive compensation and benefits packages 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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