Sr. Claims Specialist (BI/PIP/ Litigation) - Fremont

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Job Type:

Full time

 

Exempt/Non Exempt:

 

Salary

Job Description:

 

Sr. Claims Specialist (BI/PIP/Litigation) – Fremont

What you will do: (Primary Duties & Responsibilities)

The Auto Club Group is seeking a prospective Sr. Claims Specialist works 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:

• 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.

• 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.

Claim Specialists assigned to the PIP unit are responsible for Michigan PIP intermediate claims involving fractures, mild closed head injuries, surgical procedures, and claims involving attendant care. The role will require proficiency in dealing with the MCCA and attorney represented claims. May handle losses beyond those identified previously. 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 Sr. Claims Specialist can lead to a rewarding career at our growing organization.

Work Environment

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.

How you will benefit:

Senior Claim Specialist will earn a competitive salary of $72,700 to $96,900 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 Match

• Medical

• Dental

• Vision

• PTO

• Paid Holidays

• Tuition Reimbursement

We’re looking for candidates who: (Required/Preferred Qualifications)

Required Qualifications (these are the minimum requirements to qualify)

Education (include minimum education and any licensing/certifications):

• Complete ACG Claim Representative 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 as specified for appropriate states.

• Must have a valid State Driver's License

Experience:

Five years of experience in the following:

• Negotiation of claims settlements

• Securing and evaluating settlements

• Preparing manual and electronic estimates

• Subrogation claims

• Resolving coverage questions

• Taking statements

• Establishing cle