Senior Casualty Litigation Claim Specialist

Overview

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Job Type: Full time

Exempt/Non Exempt: Exempt/Non Exempt

Job Description: Senior Claim Specialist Casualty - The Auto Club Group

Report to: Claim Manager II

• Review assigned claims, contact the insured and other affected parties, set expectations for the remainder of the claim process, and initiate documentation in the claim handling system.
• Complete coverage analysis on the most complex claims.
• Handle large loss injury claims.
• Ensure all possible policyholder benefits are identified.
• Create additional sub-claims if needed.
• Complete an investigation of the facts regarding the claim to 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.

Note: Senior Claim Specialists are assigned Liability/BI/Med Pay/Non-MI, PIP/HO Liability/UM/UIM claims involving litigation/arbitration. They handle the most complex claims involving liability disputes, bodily injuries, and coverage questions.

How you will benefit: Senior Claim Specialist will earn a competitive salary of $80,000 to $95,000 annually with annual bonus potential based on performance.

• Excellent and comprehensive benefits packages are provided, including:
• 401k Match
• Medical
• Dental
• Vision
• PTO
• Paid Holidays
• Tuition Reimbursement

Required Qualifications (minimum requirements)

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
• Complete the ACG 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 it as specified for the appropriate states.
• Must have a valid State Driver's License

• Experience:
• Five years of experience in the following areas: 1st and 3rd party auto injury, homeowner liability, personal injury, and umbrella policies
• Managing and handling claims where litigation or arbitration has been filed
• Working with defense counsel
• Multi-state claim/venue knowledge
• Resolving complex coverage questions
• Large loss claims
• Negotiation of complex claim settlements
• Securing and evaluating evidence and claims supports
• Comfort with multi-system and software program usage
• Subrogation claims and investigation
• Taking statements
• Establishing clear evaluation and resolution plans for claims

• Knowledge and
  
  Skills:
  
  
• Advanced technical knowledge of the Essential Insurance Act (Michigan)
• Fair Trade Practices Act as it relates to claims
• Subrogation procedures and processes
• Microsoft products
• Intercompany arbitration
• Litigation
• Large Loss
• Coverage
• Medical terminology
• Advanced technical knowledge of negligence law, No-Fault law, medical terminology and human anatomy, Insurance Policy Review and Understanding, Coverage Review and letter writing

• Ability to:
• Handle claims according to the established Claim Handling Standards
• Follow and apply ACG Claim policies, procedures, and guidelines
• Work within the assigned ACG Claim systems, including basic PC software
• Perform 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 understanding 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 workload and responsibilities
• Safely operate a motor vehicle to attend meetings off-site
• Travel outside of the assigned territory, which may involve overnight stay
• Relocate, work evenings or weekends

This position is currently able to work remotely from a home office location for day-to-day operations unless occasional travel for meetings, collaborative activities, or team building activities is specified by leadership. This is subject to change based on amendments and/or modifications to the ACG Flex Work policy.

The Auto Club Group (ACG) provides membership, travel, insurance, and financial service offerings to approximately 14+ million members and customers across 14…