Claim Representative II

<p><strong>A career at The Auto Club Group (ACG) can be satisfying, exciting and rewarding. By aligning your professional development with our business objectives, ACG can help you attain your career goals &mdash; and make a difference. Get started by choosing the career that&rsquo;s right for you.</strong></p>

Aurora, IL

The Auto Club Group

AAA was founded over 100 years ago for the purpose of lobbying for driver and passenger rights, fair laws and safer vehicles — all to better promote the love of the open road and the adventure of driving. Since then, AAA has grown to over 50 million members strong, while providing valuable membership services such as roadside assistance. Additionally, AAA has broadened its horizons to include all types of travel-related services, as well as offer a variety of insurance and financial products and services. Today’s AAA is a national federation comprised of more than 50 individual clubs throughout the United States and Canada. Whether you’re traveling around the world or to the corner grocery store, planning a honeymoon or weekend road trip, learning to drive or in need of a battery boost, the best way to begin your journey is with AAA. http://michigan.aaa.com/

keywords: about acg,work environment,compensation,analysis,management,claims,investigate,medical,document,training,analysis,knowledge,education,license,perform

Full-Time

Competitive Compensation and Benefits Package

Overview: The Auto Club Group (ACG) provides membership, travel, insurance and financial services offerings to approximately 9 million members and customers across 11 states and 2 U.S. territories through the AAA, Meemic and Fremont brands. ACG belongs to the national AAA federation and is the second largest AAA club in North America.&nbsp;<br /><br /> <div><strong><span style="font-size: medium;">Work Environment</span></strong></div> <div><span style="font-size: medium;">Works in a temperature controlled office environment.&nbsp; Depending on line frequent travel may be required to various repair facilities in order to conduct inspections/re-inspections, visit patients, hospitals, attorneys, rehabilitation centers, repair facilities, etc. Per with exposure to road hazards and temperature extremes. For Homeowners and CAT may require deployment to territories impacted by storms.</span></div> <br />The Auto Club Group offers a competitive compensation and benefits package including a base salary with performance based incentives; medical/dental/vision insurance,&nbsp; 401(k), generous time off, a complimentary AAA Membership and much more!
Responsibilities: <p><span style="font-family: Arial; font-size: medium;"><u><strong>Primary Duties and Responsibilities (details of the basic job functions):</strong></u></span></p> <ul> <li><span style="font-family: Arial; font-size: medium;">Work under normal supervision with an intermediate-level approval authority to handle moderately complex claims within Claim Handling Standards in the field or inside units.&nbsp; </span></li> <li><span style="font-family: Arial; font-size: medium;">Resolve coverage questions, take statements and establish clear evaluation and resolution plans for claims.</span></li> <li><span style="font-size: medium;">Claim handling responsibilities will include the following: reviewing assigned claims, contacting the insured and other affected parties, setting expectations for the remainder of the claim, and initiating documentation in the claim handling system.&nbsp;&nbsp; </span></li> <li><span style="font-size: medium;">Complete coverage analysis including a review of policy coverages and provisions, and the applicability to the reported loss. Ensure all possible policyholder benefits are identified, create additional sub-claims if needed or refer complex claims to management or the appropriate claim handler.&nbsp; </span></li> <li><span style="font-size: medium;">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. </span></li> <li><span style="font-size: medium;">Conduct thorough reviews of damages and determine the applicability of state law and other factors related to the claim. </span></li> <li><span style="font-size: medium;">Evaluate the financial value of the loss. Approve payments for the appropriate parties accordingly.&nbsp; </span></li> <li><span style="font-size: medium;">Refer claims to other company units when necessary (e.g., Underwriting, Recovery Units or Claims Special Investigation Unit).&nbsp; </span></li> <li><span style="font-size: medium;">Thoroughly document and/or code the claim file and complete all claim closure and related activities in the assigned claims management system.&nbsp; &nbsp;</span></li> <li><span style="font-size: medium;">Utilize strong negotiating skills.</span></li> </ul> <p><strong><span style="font-size: medium;">Additional Items to Post for Auto Physical Damage (&ldquo;APD&rdquo;) Units Only:</span></strong></p> <ul> <li><span style="font-size: medium;">Employees assigned to Auto Physical Damage (&ldquo;APD&rdquo;) claim unit will handle moderately complex claims involving settling Total Losses, inspecting vehicles and preparing estimates of damage. </span></li> <li><span style="font-size: medium;">If in the DRS Examiner role, manage Direct Repair Shops for compliance with our program. </span></li> <li><span style="font-size: medium;">Additional responsibilities may include the following: determining cause of damage, establishing liability, identifying subrogation potential, monitoring repairs and approving car rental expense.&nbsp; </span></li> <li><span style="font-size: medium;">May handle simple APD Litigation cases.</span></li> </ul> <p><strong><span style="font-size: medium;">Additional Items to Post for Liability/Bodily Injury/Med Pay/MRTS/Non-MI PIP Units Only:</span></strong></p> <ul> <li><span style="font-size: medium;">Employees assigned to the Liability, Bodily Injury, Med Pay, MRTS and Non-MI PIP claim units will handle moderately complex claims involving liability disputes, bodily injuries, and generally valued up to $50,000.&nbsp; </span></li> <li><span style="font-size: medium;">Answer coverage and policy questions.&nbsp; </span></li> <li><span style="font-size: medium;">Handle Med Pay claims in all states, and PIP claims in KY, MN and ND.&nbsp; </span></li> <li><span style="font-size: medium;">Apply the correct liability determination, evaluate the damages and arrive at a fair settlement.</span></li> </ul> <p><strong><span style="font-size: medium;">Additional Items to Post for Michigan Personal Injury Protection (&ldquo;PIP&rdquo;) Units Only:</span></strong></p> <ul> <li><span style="font-size: medium;">Employees assigned to PIP claim unit are responsible for Michigan PIP Fast Track claims involving minor injuries.&nbsp; </span></li> <li><span style="font-size: medium;">Claims will include emergency room treatment and release, primary care physician treatment, and injuries requiring very little follow-up care.&nbsp; </span></li> <li><span style="font-size: medium;">May handle losses beyond those identified previously. Work with insureds, physicians&rsquo; offices and medical insurance carriers to obtain necessary information to complete the claims review process and make the appropriate determinations.</span></li> </ul> <p><strong><span style="font-size: medium;">Additional Items to Post for Homeowners and Homeowners CAT Units Only:</span></strong></p> <ul> <li><span style="font-size: medium;">Employees assigned to Homeowner/CAT claim unit will handle claims generally valued between $5,000 and $25,000 (for the inside desk role) and up to $100,000 (for field role). Investigate claims requiring coverage analysis.&nbsp; When handling claims in the field, must prepare damage estimates using claims software.&nbsp; Review estimates for accuracy. May monitor contractor repair status and updates.&nbsp;&nbsp;</span></li> </ul> <p><strong><span style="font-size: medium;">Additional Items to Post for Recovery Units Only:</span></strong></p> <ul> <li><span style="font-size: medium;">Employees assigned to a Recovery unit will complete recovery tasks on moderately complex claims for all lines of business.&nbsp; </span></li> <li><span style="font-size: medium;">The tasks may not cover the entire lifecycle of a claim but will be an expansion of those aspects related to the financial recovery of funds previously paid on a claim from liable parties or other insurance carriers. </span></li> <li><span style="font-size: medium;">Additional responsibilities may include the following: Evaluating and presenting proofs to support both liability and damage decisions; applying knowledge of venues, negligence laws and case law associated with recovery for all states to determine handling strategies; participating in the arbitration process as an applicant, respondent-counter applicant and as an arbitrator rendering decisions on cases presented to Arbitration Forums; negotiating, settling and recovering receipts; ensuring that funds recovered are accounted for appropriately and settlements are maximized.</span></li> </ul> <p><u><span style="font-size: medium;">Supervisory Responsibilities (briefly describe, if applicable, or indicate None):</span></u></p> <ul> <li><span style="font-size: medium;">None</span></li> </ul>
Requirements: <div><span style="font-size: medium;"><u><strong>Preferred Qualifications</strong></u></span></div> <div><u><span style="font-size: medium;">Education:</span></u></div> <ul> <li><span style="font-size: medium;">Associate degree in Business Administration, Insurance or a related field or the equivalent in related work experience</span></li> <li><span style="font-size: medium;">Completion of the Insurance Institute of America's: General Insurance Program, Associate in Claims, Associate in Management or equivalent</span></li> <li><span style="font-size: medium;">CPCU coursework or designation</span></li> <li><span style="font-size: medium;">I-Car 2000 training</span></li> <li><span style="font-size: medium;">CCC training</span></li> <li><span style="font-size: medium;">Xactware Training</span></li> </ul> <p><strong><span style="font-size: medium;">Post for Homeowners/CAT Units Only:</span></strong></p> <div><u><span style="font-size: medium;">Ability to:</span></u></div> <ul> <li><span style="font-size: medium;">Lift up to 25 pounds</span></li> <li><span style="font-size: medium;">Climb ladders</span></li> <li><span style="font-size: medium;">Walk on roofs</span></li> </ul> <span style="font-size: medium;"><span style="font-size: medium;"><strong>Qualifications<br /></strong></span></span><u><span style="font-size: medium;">Education (include minimum education and any licensing/certifications):</span></u> <ul> <li><span style="font-size: medium;">Complete ACG Claim Representative Training Program or demonstrate equivalent knowledge or experience</span></li> <li><span style="font-size: medium;">In states where an Adjuster&rsquo;s license is required, the candidate must be eligible to acquire a State Adjuster&rsquo;s license within 90 days of hire and maintain as specified for appropriate states.</span></li> <li><span style="font-size: medium;">Must have a valid State Driver's License</span></li> </ul> <div><span style="font-size: medium;"><u>&nbsp;</u><u>Experience:</u></span></div> <ul> <li><span style="font-size: medium;">One year of experience with:</span></li> <li><span style="font-size: medium;">Negotiating claim settlements</span></li> <li><span style="font-size: medium;">Securing and evaluating evidence</span></li> <li><span style="font-size: medium;">Preparing manual and electronic estimates</span></li> <li><span style="font-size: medium;">Subrogation claims</span></li> <li><span style="font-size: medium;">Resolving coverage questions</span></li> <li><span style="font-size: medium;">Taking statements</span></li> <li><span style="font-size: medium;">Establishing clear evaluation and resolution plans for claims</span></li> </ul> <div><span style="font-size: medium;"><u>Knowledge and Skills:<br /></u></span><span style="font-size: medium;">Knowledge of:</span></div> <ul> <li><span style="font-size: medium;">Essential Insurance Act (Michigan)</span></li> <li><span style="font-size: medium;">Fair Trade Practices Act as it relates to claims</span></li> <li><span style="font-size: medium;">Subrogation procedures and processes</span></li> <li><span style="font-size: medium;">Intercompany arbitration</span></li> </ul> <div><strong><span style="font-size: medium;">Additional Items to Post for APD Units Only:</span></strong></div> <div><span style="font-size: medium;">Knowledge of:</span></div> <ul> <li><span style="font-size: medium;">Negligence Law</span></li> <li><span style="font-size: medium;">No-Fault Law</span></li> <li><span style="font-size: medium;">Collision repair techniques</span></li> </ul> <div><strong><span style="font-size: medium;">Additional Items to Post for Liability, Bodily Injury, Med Pay, MRTS, Non-MI Personal Injury Protection (&ldquo;PIP&rdquo;) and Michigan PIP Units Only:</span></strong></div> <div><span style="font-size: medium;">Knowledge of:</span></div> <ul> <li><span style="font-size: medium;">Negligence Law</span></li> <li><span style="font-size: medium;">No-Fault Law</span></li> <li><span style="font-size: medium;">Medical terminology and human anatomy</span></li> </ul> <div><strong><span style="font-size: medium;">Additional Items to Post for Homeowners and Homeowners CAT Units Only:</span></strong></div> <div><span style="font-size: medium;">Knowledge of:</span></div> <ul> <li><span style="font-size: medium;">Knowledge of building construction and repair techniques</span></li> </ul> <div><span style="font-size: medium;">Ability to:</span></div> <div><strong><span style="font-size: medium;">Post for All Claim Units:</span></strong></div> <ul> <li><span style="font-size: medium;">Handle claims to the line Claim Handling Standards</span></li> <li><span style="font-size: medium;">Follow and apply ACG Claim policies, procedures and guidelines</span></li> <li><span style="font-size: medium;">Work within assigned ACG Claim systems including basic PC software</span></li> <li><span style="font-size: medium;">Perform basic claim file review and investigations</span></li> <li><span style="font-size: medium;">Demonstrate effective communication skills (verbal and written)</span></li> <li><span style="font-size: medium;">Demonstrate customer service skills by building and maintaining relationships with insureds/claimants while exhibiting understanding of their problems and responding to questions and concerns</span></li> <li><span style="font-size: medium;">Analyze and solve problems while demonstrating sound decision making skills</span></li> <li><span style="font-size: medium;">Prioritize claim related functions</span></li> <li><span style="font-size: medium;">Process time sensitive data and information from multiple sources</span></li> <li><span style="font-size: medium;">Manage time, organize and plan work load and responsibilities</span></li> <li><span style="font-size: medium;">Safely operate a motor vehicle in order to visit repair facilities, homes (for inspections), patients, etc.</span></li> <li><span style="font-size: medium;">Research analyze and interpret subrogation laws in various states</span></li> <li><span style="font-size: medium;">Travel outside of assigned territory which may involve overnight stay</span></li> <li><span style="font-size: medium;">Relocate, work evenings or weekends</span></li> <li><span style="font-size: medium;">Strong negotiating skills</span></li> </ul> <span style="font-size: medium;">Important Note: The above statements describe the principal and essential functions, but not all functions that may be inherent in the job. This job requires the ability to perform duties contained in the job description for this position, including, but not limited to, the above requirements. Reasonable accommodations will be made for otherwise qualified applicants, as needed, to enable them to fulfill these requirements.</span>