Claim Customer Service Representative (Charlotte, NC)

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Job Type:

Full time

 

Exempt/Non Exempt:

 

Hourly

Job Description:

 

Position Description

Primary Duties and Responsibilities:

Responsible for taking first notice of loss, handling claim inquiries, initiating claim services, and handling low-complexity, one-touch claims in a call center environment.   

Identifies non-complex claims for one-touch claim adjudication upon intake.   Determines the type and extent of loss and ensures the claim is consistent with all reported facts.  Reviews necessary legal and police/fire reports to process claims as necessary.   Interprets policy language and applies coverage to authorize or deny claims.  Initiates services, authorizes, and resolves issues related to services such as car rental and vehicle repairs and non-complex homeowner claims (e.g. food spoilage).  Initiates and creates payments, settles or recommends settlement value of claims within specified limits.  Identifies additional claim exposures and creates sub-claims as necessary.  Refers files for investigation as warranted.  Informs insured of coverage decision on claims within defined scope.  Responds to claimant inquiries and explains payments.  Documents claim files.  Reviews the status of open and closed reserves and makes adjustments consistent with exposures.  Identify claims for salvage and subrogation potential in accordance to company policy.  Closes claims in a timely manner.  Ensure compliance with state regulations.

Completes first notice of loss (FNOL) for all policy products and handles inbound claim inquiries received via phone, the ACG website and other sources. Explains the benefits of company programs to customers, and  initiates services, such as arranging for repair inspections, vehicle tows and car rental. Provides basic information to members regarding claims procedures in accordance with Customer Interaction Model.  Promotes customer satisfaction and provides seamless service to ensure customer service goals and standards are met.  Navigates through various sources of information and claim processing systems (E.g., FACTS, CPS, Point of Sale, IPM insurance systems, Intranet/Internet, manuals and call center models). Responds to members/customers questions in a timely manner. 

Required Qualifications (these are the minimum requirements to qualify):

Education:

• Completion of AAA approved call center training program, appropriate level ACG Claim Representative Training program and ongoing training and certification for the position

• Must be eligible to acquire and maintain a State adjuster’s license for appropriate state(s).

Experience:

• processing FNOL information and handling claim inquiries utilizing PCs and software packages (e.g. ACG claim systems, Microsoft Word, Excel)

• reading and comprehending various Customer Care service tools (manuals, work models, etc.)

• performing mathematical calculations including adding, subtracting, percentages, etc.

• analyzing and resolving problems

Knowledge and Skills:

Knowledge of:

• claim processing policy and procedures

• general claim processing functions

• claim processing systems

• telephone etiquette

Ability to:

• provide a high level of customer service in a professional call center environment using the following skills:

• strong interpersonal skills demonstrated through work experience, participation in extra-curricular activities and/or community involvement

• strong communication skills required in understanding customers’ concerns and to provide high quality customer service as demonstrated through the effective use of the customer care call center model

• excellent verbal communication skills service

• strong written communications skills (example may be required at time of interview) needed to respond in a professional manner to members/customers inquiries

• effective listening skills

Ability to learn and apply claim handling skills, including:

• policy analysis and coverage application

• claim payment coding, issuance, and exception handling

• proactive customer contact and issue resolution

• car rental coverage knowledge

• claims’ related policies and procedures

• auto and home repa