Senior Casualty Litigation Claim Specialist

AAA-The Auto Club Group

3d•$80,000 - $95,000•Remote

About The Position

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. Senior Claim Specialist Casualty– The Auto Club Group Report to: Claim Manager II What you will do: In this position, you will have the opportunity to: Review assigned claims, contact the insured and other affected parties, set expectations for the remainder of the claim process, and initiate documentation in the claim handling system. Complete coverage analysis on the most complex claims. Handle large loss injury 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. Senior Claim Specialists are assigned Liability/BI/MedPay/Non-MI PIP/HO Liability/UM/UIM claims involving litigation/arbitration. The Senior Claim Specialists handle the most complex claims involving liability disputes, bodily injuries, and coverage questions.

Requirements

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 CPCU coursework or designation
Complete the ACG 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 it as specified for the appropriate states.
Must have a valid State Driver's License
Five years of experience in the following:
1st and 3rd party auto injury, homeowner liability, personal injury, and umbrella policies
Managing and handling claims where litigation or arbitration has been filed
Working with defense counsel
Multi-state claim/venue knowledge
Resolving complex coverage questions
Large loss claims
Negotiation of complex claim settlements
Securing and evaluating evidence and claims supports
Comfort with multi-system and software program usage
Subrogation claims and investigation
Taking statements
Establishing clear evaluation and resolution plans for claims
Advanced technical knowledge of Essential Insurance Act (Michigan)
Fair Trade Practices Act as it relates to claims
Subrogation procedures and processes
Microsoft products
Intercompany arbitration
Litigation
Large Loss Coverage
Medical terminology
Advanced technical knowledge of: Negligence Law
No-Fault Law medical terminology and human anatomy
Insurance Policy Review and Understanding
Coverage Review and letter writing
Handle claims according to the established Claim Handling Standards
Follow and apply ACG Claim policies, procedures, and guidelines
Work within the assigned ACG Claim systems, including basic PC software
Perform claim file review and investigations
Demonstrate effective communication skills (verbal and written)
Demonstrate customer service skills by building and maintaining relationships with insureds/claimants while exhibiting understanding of their problems and responding to questions and concerns
Analyze and solve problems while demonstrating sound decision-making skills
Prioritize claim-related functions
Process time-sensitive data and information from multiple sources
Manage time, organize, and plan workload and responsibilities
Safely operate a motor vehicle in order to attend meetings off-site
Travel outside of the assigned territory, which may involve overnight stay
Relocate, work evenings or weekends

Nice To Haves

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 CPCU coursework or designation

Responsibilities

Review assigned claims, contact the insured and other affected parties, set expectations for the remainder of the claim process, and initiate documentation in the claim handling system.
Complete coverage analysis on the most complex claims.
Handle large loss injury 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.
Senior Claim Specialists are assigned Liability/BI/MedPay/Non-MI PIP/HO Liability/UM/UIM claims involving litigation/arbitration.
The Senior Claim Specialists handle the most complex claims involving liability disputes, bodily injuries, and coverage questions.