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Intermediate PIP Claims Adjuster - Dearborn Michigan
Company: The Auto Club Group Location: Dearborn, Michigan
Posted On: 05/03/2024
It's a great time to join AAA The Auto Club Group!JOIN THE TEAM COMMITTED TO DRIVING YOUR CAREER FORWARDJob Type:Full timeExempt/Non Exempt:SalaryJob Description:Intermediate PIP Claims Adjuster - The Auto Club GroupWhat you will do: (Primary Duties & Responsibilities)The Auto Club Group is seeking prospectiveClaims Specialist who will work under minimal supervision with a high-level approval authority to handle complex technical issues and 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 complex coverage analysis.
- 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.Claims 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 aClaims Specialistcan lead to a rewarding career at our growing organization.Work EnvironmentThis 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 annually $65,000 to $80,000 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 ReimbursementWe're looking for candidates who: (Preferred/Required Qualifications)Education:
- Complete ACG Claim Representative Training Program or demonstrate equivalent knowledge or experience
- Associate degree in Business Administration, Insurance or a related field or the equivalent in related work experience
- Completion of the Insurance Institute of America's: General Insurance Program, Associate in Claims, Associate in Management or equivalent
- 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 LicenseExperience:Three years of experience or equivalent training in the following:
- Negotiation of claim settlements
- Securing and evaluating evidence
- Preparing manual and electronic estimates
- Subrogation claims
- Resolving coverage questions
- Taking statements
- Establishing clear evaluation and resolution plans for claimsKnowledge and Skills:
- Essential Insurance Act (Michigan)
- Fair Trade Practices Act as it relates to claims
- Subrogation procedures and processes
- Intercompany arbitration
- Handling simple litigationAdvanced technical knowledge of:
- Negligence Law
- Michigan No-Fault Law
- Medical terminology and human anatomy
- MCCA and attorney represented claimsAbility to:
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