Claim Customer Service Representative

Claim Customer Service Representative

As a Claim Customer Service Representative, you will serve as the first point of contact for members reporting losses, guiding them through the claims process with professionalism, empathy, and efficiency. In this fast-paced call center environment, you will handle claim inquiries, initiate claim services, and resolve low-complexity, one-touch claims by interpreting coverage, authorizing services, processing payments, and ensuring compliance with company policies and state regulations.

This role combines strong customer service, critical thinking, and claims handling expertise to deliver seamless support and timely claim resolution while promoting a positive member experience.

Key Responsibilities:

• Responsible for taking first notice of loss
• Handling claims inquiries
• Identifies non-complex claims for one-touch claim adjudication upon intake
• Determines the type and extent of loss and ensures the claim is consistent with all reported facts
• Reviews necessary legal and police/fire reports to process claims as necessary
• Interprets policy language and applies coverage to authorize or deny claims
• Initiates services, authorizes, and resolves issues related to services such as car rental and vehicle repairs and non-complex homeowner claims (e.g. food spoilage)
• Initiates and creates payments
• Settles or recommends settlement value of claims within specified limits
• Identifies additional claim exposures and creates sub-claims as necessary
• Refers files for investigation as warranted
• Informs insured of coverage decision on claims within defined scope
• Responds to claimant inquiries and explains payments
• Documents claim files
• Reviews the status of open and closed reserves and makes adjustments consistent with exposures
• Identifies claims for salvage and subrogation potential in accordance with company policy
• Closes claims in a timely manner
• Ensures compliance with state regulations
• Completes first notice of loss (FNOL) for all policy products and handles inbound claim inquiries received via phone, the ACG website and other sources
• Provides basic information to members regarding claims procedures in accordance with Customer Interaction Model
• Promotes customer satisfaction and provides seamless service to ensure customer service goals and standards are met
• Navigates through various sources of information and claim processing systems (E.g., FACTS, CPS, Point of Sale, IPM insurance systems, Intranet/Internet, manuals and call center models)

Qualifications:

Required

Education:

• Completion of AAA approved call center training program, appropriate level ACG Claim Representative Training program and ongoing training and certification for the position
• Must be eligible to acquire and maintain a state adjuster's license for appropriate state(s).

Experience:

• Processing FNOL information and handling claim inquiries utilizing PCs and software packages (e.g. ACG claim systems, Microsoft Word, Excel)
• Reading and comprehending various Customer Care service tools (manuals, work models, etc.)
• Performing mathematical calculations including adding, subtracting, percentages, etc.
• Analyzing and resolving problems

Knowledge and

Skills:

Knowledge of:

• Claim processing policy and procedures
• General claim processing functions
• Claim processing systems
• Telephone etiquette

Ability to:

Provide a high level of customer service in a professional call center environment using the following skills:

• Strong interpersonal skills demonstrated through work experience, participation in extra-curricular activities and/or community involvement
• Strong communication skills required in understanding customers' concerns and to provide high-quality customer service as demonstrated through the effective use of the customer care call center model
• Excellent…