Michigan Medicare Claim Representative II

Michigan Medicare Claim Representative II - The Auto Club Group

The Auto Club Group is seeking prospective Claim Representative II who will work under normal supervision with an intermediate-level approval authority to handle moderately complex claims within Claim Handling Standards in the field or inside units. Resolve coverage questions, take statements and establish clear evaluation and resolution plans for 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, and initiating documentation in the claim handling system.
• Complete coverage analysis including a review of policy coverages and provisions, and the applicability to the reported loss.
• Ensure all possible policyholder benefits are identified, create additional sub-claims if needed or refer complex claims to management or the appropriate claim handler.
• 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.

Employees assigned to the Liability, Bodily Injury, Med Pay, MRTS and Non-MI PIP claim units will handle moderately complex claims involving liability disputes, bodily injuries, and generally valued up to $50,000. Answer coverage and policy questions. Handle Med Pay claims in all states, and PIP claims in KY, MN and ND. Apply the correct liability determination, evaluate the damages and arrive at a fair settlement.

Supervisory Responsibilities (briefly describe, if applicable, or indicate None) : None

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 will you benefit :

We're looking for candidates who :

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

Experience :

Knowledge and Skills :

Ability to :

Preferred Qualifications :