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Senior Litigation Casualty Claim Specialist
4 weeks ago
Senior Litigation Casualty Claim Specialist (Michigan PIP) The Auto Club GroupThe Auto Club Group is seeking prospective Senior Claim Specialist who can work under less supervision with a high level of authority to handle highly complex technical issues and the most complex claims.In this position, you will have the opportunity to: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.Ensure all possible policyholder benefits are identified.Create additional sub-claims if needed.Complete an investigation of the facts regarding the claim to further and in more detail 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.Senior Claim Specialist assigned to the PIP unit are responsible for claims involving the MCCA or quadriplegic, traumatic brain, amputations, and other catastrophic injuries. The role will require proficiency in dealing with the MCCA and attorney represented claims. Work with insureds, physicians' offices, and medical insurance carriers to obtain necessary information to complete the claims review process and make the appropriate determinations.With our powerful brand and the mentoring we offer, you will find your position as a Senior Claim Specialist can lead to a rewarding career at our growing organization.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.Senior Claim Specialist will earn a competitive salary of $74,900 to $99,800 annually with annual bonus potential based on performance.Excellent and comprehensive benefits packages are just another reason to work for the Auto Club Group. Benefits include:401k MatchMedicalDentalVisionPTOPaid HolidaysTuition ReimbursementWe're looking for candidates who:Required Qualifications (these are the minimum requirements to qualify)Complete ACG Claim Representative Training Program or demonstrate equivalent knowledge or experienceIn 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.A valid driver's license is required if the primary responsibilities of the role involve conducting in-person inspections or frequent in-person meetings with members.Experience:Five years of experience in the following:Negotiation of complex claim settlementsSecuring and evaluating evidencePreparing manual and electronic estimatesSubrogation claimsResolving complex coverage questionsTaking statementsEstablishing clear evaluation and resolution plans for claimsKnowledge and Skills:Advanced technical knowledge of:Essential Insurance Act (Michigan)Fair Trade Practices Act as it relates to claimsSubrogation procedures and processesIntercompany arbitrationLitigationAdvanced technical knowledge of:Negligence LawNo-Fault LawMedical terminology and human anatomyMCCA and attorney represented claimsAbility to:Handle claims to the line Claim Handling StandardsFollow and apply ACG Claim policies, procedures and guidelinesWork within assigned ACG Claim systems including basic PC softwarePerform claim file review and investigationsDemonstrate effective communication skills (verbal and written)Demonstrate customer service skills by building and maintaining relationships with insureds/claimants while exhibiting understanding of their problems and responding to questions and concernsAnalyze and solve problems while demonstrating sound decision making skillsPrioritize claim related functionsProcess time sensitive data and information from multiple sourcesManage time, organize and plan workload and responsibilitiesAttend virtual meetings and corporate/court onsite meetingsPreferred QualificationsEducationAssociate degree in Business Administration, Insurance or a related field or the equivalent in related work experienceCompletion of the Insurance Institute of America's: General Insurance Program, Associate in Claims, Associate in Management or equivalentCPCU coursework or designation
