Senior Claim Specialist - Medical Management Unit

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 — and make a difference. Get started by choosing the career that’s right for you.

Dearborn, MI

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/

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Senior

Competitive compensation and benefits

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 />The Auto Club Group offers a competitive compensation and benefits package including a base salary with performance based incentives; medical/dental/vision insurance, pension, 401(k), generous time off, a complimentary AAA Membership and much more!<br /><br /> <div><strong><u><span style="font-family: Arial; font-size: medium;">Work Environment</span></u></strong></div> <div><span style="font-family: Arial; font-size: medium;">Works in a temperature controlled office environment.&nbsp; Depending on line travel may be required to visit courts, attorney offices, patients, hospitals, rehabilitation centers, repair facilities, damaged homes, contractors, etc. per with exposure to road hazards and temperature extremes.&nbsp;</span></div>
Responsibilities: <div><span style="font-family: Arial; font-size: medium;">Work under less supervision with a high-level of authority to handle highly complex&nbsp;</span><span style="font-family: Arial; font-size: large;">catastrophic injury claims.<strong>&nbsp;</strong></span></div> <div><span style="font-family: Arial; font-size: medium;">&nbsp;</span></div> <div><span style="font-family: Arial; 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 process, and initiating documentation in the claim handling system.&nbsp;&nbsp; Complete coverage analysis on the most complex claims. Ensure all possible policyholder benefits are identified.&nbsp; Create additional sub-claims if needed.&nbsp; 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.&nbsp; 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.&nbsp; Refer claims to other company units when necessary (e.g., Underwriting, Recovery Units or Claims Special Investigation Unit).&nbsp; Thoroughly document and/or code the claim file and complete all claim closure and related activities in the assigned claims management system.&nbsp;&nbsp; Utilize strong negotiating skills.</span></div> <div><span style="font-family: Arial; font-size: medium;">&nbsp;</span></div> <div><span style="font-family: Arial; font-size: medium;">&nbsp;</span></div> <div><span style="font-family: Arial; font-size: medium;">Senior Claims Specialists 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&rsquo; offices and medical insurance carriers to obtain necessary information to complete the claims review process and make the appropriate determinations.</span></div>
Requirements: <div><strong><u><span style="font-family: Arial; font-size: medium;">Preferred Qualifications</span></u></strong></div> <div><u><span style="font-family: Arial; font-size: medium;">Education:</span></u></div> <ul type="disc"> <li><span style="font-family: Arial; 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-family: Arial; 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-family: Arial; font-size: medium;">CPCU coursework or designation</span></li> <li><span style="font-family: Arial; font-size: medium;">Xactware Training</span></li> </ul> <div><span style="font-family: Arial; font-size: medium;">&nbsp;</span></div> <div><span style="font-family: Arial; font-size: medium;">Ability to:</span></div> <ul type="disc"> <li><span style="font-family: Arial; font-size: medium;">Present claims facts to management, legal, and/or MCCA, as necessary.</span></li> <li><span style="font-family: Arial; font-size: medium;">Attend team meetings with injured parties, their families, and treatment teams, as needed.</span></li> </ul> <div><span style="font-family: Arial; font-size: medium;">&nbsp;</span></div> <div><u><span style="font-family: Arial; font-size: medium;">Knowledge and Skills:</span></u></div> <div><span style="font-family: Chiller; font-size: medium;">&bull;</span><span style="font-family: Arial; font-size: medium;"><span style="font-family: Arial; font-size: medium;">&nbsp;Strong math/analytical skills<br /><br /></span></span> <div><strong><u><span style="font-family: Arial; font-size: medium;">Required Qualifications (these are the minimum requirements to qualify)</span></u></strong></div> <div><strong><u><span style="font-family: Arial; font-size: medium;">Education (include minimum education and any licensing/certifications):</span></u></strong></div> <ul type="disc"> <li><span style="font-family: Arial; font-size: medium;">Complete ACG Claim Representative Training Program or demonstrate equivalent knowledge or experience</span></li> <li><span style="font-family: Arial; 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-family: Arial; font-size: medium;">Must have a valid State Driver's License</span></li> </ul> <div><u><span style="font-family: Arial; font-size: medium;">Experience:</span></u></div> <ul type="disc"> <li><span style="font-family: Arial; font-size: medium;">Five years of experience in the following:</span></li> <li><span style="font-family: Arial; font-size: medium;">Handling Michigan PIP claims</span></li> <li><span style="font-family: Arial; font-size: medium;">Calculating work loss claims</span></li> <li><span style="font-family: Arial; font-size: medium;">Negotiation of complex claim settlements</span></li> <li><span style="font-family: Arial; font-size: medium;">Securing and evaluating evidence</span></li> <li><span style="font-family: Arial; font-size: medium;">Subrogation claims</span></li> <li><span style="font-family: Arial; font-size: medium;">Resolving complex coverage questions</span></li> <li><span style="font-family: Arial; font-size: medium;">Taking statements</span></li> <li><span style="font-family: Arial; font-size: medium;">Establishing clear evaluation and resolution plans for claims</span></li> </ul> <div><u><span style="font-family: Arial; font-size: medium;">&nbsp;</span></u></div> <div><u><span style="font-family: Arial; font-size: medium;">Knowledge and Skills:</span></u></div> <ul type="disc"> <li><span style="font-family: Arial; font-size: medium;">Advanced technical knowledge of &nbsp;</span></li> <li><span style="font-family: Arial; font-size: medium;">Essential Insurance Act (Michigan)</span></li> <li><span style="font-family: Arial; font-size: medium;">Fair Trade Practices Act as it relates to claims</span></li> <li><span style="font-family: Arial; font-size: medium;">Subrogation procedures and processes</span></li> <li><span style="font-family: Arial; font-size: medium;">Intercompany arbitration</span></li> <li><span style="font-family: Arial; font-size: medium;">Litigation</span></li> </ul> <div><span style="font-family: Arial; font-size: medium;">Advanced technical knowledge of:</span></div> <ul type="disc"> <li><span style="font-family: Arial; font-size: medium;">Negligence Law</span></li> <li><span style="font-family: Arial; font-size: medium;">No-Fault Law</span></li> <li><span style="font-family: Arial; font-size: medium;">Medical terminology and human anatomy</span></li> <li><span style="font-family: Arial; font-size: medium;">MCCA and attorney represented claims</span></li> </ul> <div><strong><span style="font-family: Arial; font-size: medium;">&nbsp;</span></strong></div> <div><span style="font-family: Arial; font-size: medium;">Ability to:</span></div> <ul type="disc"> <li><span style="font-family: Arial; font-size: medium;">Handle claims to the line Claim Handling Standards including but not limited to establishing &amp; maintaining an effective diary system to appropriately manage highly complex catastrophic injury claims.</span></li> <li><span style="font-family: Arial; font-size: medium;">Follow and apply ACG Claim policies, procedures and guidelines</span></li> <li><span style="font-family: Arial; font-size: medium;">Work within assigned ACG Claim systems including basic PC software</span></li> <li><span style="font-family: Arial; font-size: medium;">Perform &nbsp;claim file review and investigations</span></li> <li><span style="font-family: Arial; font-size: medium;">Demonstrate effective communication skills (verbal and written)</span></li> <li><span style="font-family: Arial; 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-family: Arial; font-size: medium;">Analyze and solve problems while demonstrating sound decision making skills</span></li> <li><span style="font-family: Arial; font-size: medium;">Prioritize claim related functions</span></li> <li><span style="font-family: Arial; font-size: medium;">Process time sensitive data and information from multiple sources</span></li> <li><span style="font-family: Arial; font-size: medium;">Manage time, organize and plan work load and responsibilities</span></li> <li><span style="font-family: Arial; font-size: medium;">Safely operate a motor vehicle in order to attend meetings off site &nbsp;</span></li> <li><span style="font-family: Arial; font-size: medium;">Travel outside of assigned territory which may involve overnight stay</span></li> <li><span style="font-family: Arial; font-size: medium;">Relocate, work evenings or weekends</span></li> </ul> </div>