Senior Claim Specialist (Medical Management Unit)

Senior Claim Specialist (Medical Management Unit) The Auto Club Group

The Auto Club Group is seeking prospective Senior Claim Specialist who can work 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.

Senior Claims Specialists assigned to the PIP unit are responsible for claims involving the MCCA or quadriplegic, traumatic brain, amputations and other catastrophic injuries. The role will require proficiency in dealing with the MCCA and attorney represented claims. Work with insureds, guardians, conservators, attorneys, treatment teams and case managers 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 Senior Claim Specialist can lead to a rewarding career at our growing organization.

The work environment for 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.

Claim Specialist will earn a competitive salary of $80,000 to $90,000 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 :

We're looking for candidates who :

Required Qualifications (these are the minimum requirements to qualify)

Experience :

Knowledge and Skills :

Ability to :

Preferred Qualifications