Michigan Claim Customer Service Representative

Michigan Claim Customer Service Representative – AAA The Auto Club Group

Reports To:

Claim Manager as appropriate

Location:

Dearborn, Michigan (must reside within 50 miles)

Job Type: Full time, Hourly, Exempt/Non‑Exempt

Attendance during the initial 90‑day training and probationary period is mandatory.

• 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 and informs insured of coverage decision on claims within defined scope.
• Responds to claimant inquiries and explains payments.
• Reviews the status of open and closed reserves and adjusts consistent with exposures; identifies claims for salvage and subrogation potential in accordance with company policy.
• Ensures compliance with state regulations.
• Completes first notice of loss for all policy products and handles inbound claim inquiries received via phone, the ACG website and other sources.
• Explains the benefits of company programs to customers and initiates services such as arranging for repair inspections, vehicle tows and car rental.
• Provides basic information to members regarding claims procedures in accordance with the 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) and responds to members/customers questions in a timely manner.

• High School Diploma or equivalent.
• 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 the appropriate state(s).

• 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.

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

• Strong interpersonal skills demonstrated through work experience, participation in extra‑curricular activities and/or community involvement.
• Strong communication skills required to understand customers’ concerns and provide high‑quality customer service as demonstrated through the effective use of the customer care call center model.
• Effective listening skills.

• Policy analysis and coverage application.
• Claim payment coding, issuance, and exception handling.
• Proactive customer contact and issue resolution.
• Car rental coverage knowledge.
• Claims‑related policies and procedures.
• Auto and home repair estimate basics and compliance review.
• State compliance requirements.
• Subrogation identification and referral (e.g., MI liability basics regarding uninsured motorists).
• Understanding insurance fraud scenarios and recognizing potential fraud indicators.
• Issuing written correspondence.
• Prioritizing claims‑related functions.
• Successfully completing at least one of the following within 9 months of hire:
  • AAA general claim policy training.
  • Policy, negligence and no‑fault training.
• Working independently.
• Working under pressure.
• Recording and maintaining information accurately and in a…