Sr. Claim Specialist; Medical Management Unit

Overview

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Full time

Exempt/Non Exempt

Sr. Claim Specialist (Medical Management Unit) - The Auto Club Group

What you will do:

• Handle highly complex technical issues and claims with a high level of authority and less supervision.
• Review assigned claims, contact the insured and 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.
• Identify all possible policyholder benefits.
• Create additional sub-claims if needed.
• Investigate the facts of the claim to determine if it should be paid, applicable limits or exclusions, and potential recovery.
• Review damages and determine applicability of state law and other factors related to the claim.
• Evaluate the financial value of the loss and approve payments to appropriate parties.
• Refer claims to other company units when necessary (e.g., Underwriting, Recovery Units, or Claims Special Investigation Unit).
• Document and code the claim file and complete all closure and related activities in the claims management system.
• Utilize strong negotiating skills.

Senior Claims Specialists assigned to the PIP unit handle claims involving the MCCA or catastrophic injuries (e.g., quadriplegia, traumatic brain injuries, amputations). The role requires proficiency in dealing with MCCA- and attorney-represented claims, and collaboration with insureds, guardians, conservators, attorneys, treatment teams, and case managers.

Work with our brand and mentoring to grow your career at AAA The Auto Club Group.

This position can be remote from a home office for day-to-day operations, with potential travel for meetings or team activities as determined by leadership. Changes may occur with the ACG Flex Work policy.

• A competitive annual salary between $76,770 and $90,000
• Medical, dental, and vision benefits
• 401k match
• Paid parental leave and adoption assistance
• PTO, company holidays, floating holidays, and volunteer day
• Tuition assistance and professional development opportunities
• AAA Membership
• Discounts, perks, rewards, and more

Required Qualifications (minimum requirements)

• Education:
  
  Complete ACG Claim Representative Training Program or equivalent knowledge/experience.
• In states requiring an Adjuster’s license, eligibility to acquire a State Adjuster’s license within 90 days of hire and maintain as required.
• Valid driver's license if the role involves in-person inspections or frequent in-person meetings.

Experience:

• Five years of experience or equivalent training in: negotiations of complex Michigan claim settlements, securing and evaluating evidence, preparing estimates, subrogation, resolving complex coverage questions, taking statements, and establishing evaluation and resolution plans.

Knowledge and

Skills:

• Essential Insurance Act (Michigan);
  Fair Trade Practices Act related to claims; subrogation procedures; intercompany arbitration; litigation.
• Advanced knowledge of Negligence Law, No-Fault Law, medical terminology, human anatomy, and MCCA/attorney-represented claims.

Ability to:

• Handle claims to the line Claim Handling Standards and apply ACG policies and guidelines.
• Work within assigned ACG Claim systems and perform basic claim file reviews and investigations.
• Demonstrate strong verbal and written communication and customer service skills.
• Analyze and solve problems with sound judgment, prioritize tasks, and manage time effectively.
• Research, analyze, and interpret subrogation laws in various states.

Education:

• Associate degree in Business Administration, Insurance, or related field, or equivalent experience.
• Completion of Insurance Institute of America programs or CPCU coursework/designation.

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Become a part of something bigger. The Auto Club Group (ACG) provides membership, travel, insurance, and financial services to millions across multiple brands. We are committed to an inclusive environment with diverse backgrounds and viewpoints.

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Note:

ACG compensation is market-competitive and may include geographic pay differentials. Salary offers are based on multiple factors including job level and location.

The Auto Club Group is an equal opportunity employer. All qualified applicants will receive consideration without regard to race, color, religion, sex, gender identity, sexual orientation, national origin, disability or protected veteran status.

Regular and reliable attendance is essential. A background and drug screen may be required for employment consideration.