Claim Representative II (Florida PIP)

Claim Representative II (Florida PIP) 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 : None

With our powerful brand and the mentoring, we offer, you will find your position as a Claim Representative II can lead to a rewarding career at our growing organization.

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 you will benefit :

We're looking for candidates who :

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

Experience : One year of experience with : Negotiating claim settlements, Securing and evaluating evidence, Preparing manual and electronic estimates, Subrogation claims, including identifying recovery opportunities.

Resolving coverage questions, Taking statements, Establishing clear evaluation and resolution plans for claims.

Knowledge of : Essential Insurance Act (Michigan), Fair Trade Practices Act as it relates to claims, Subrogation procedures and processes, Intercompany arbitration, Negligence Law, No-Fault Law, Medical terminology and human anatomy.

Ability to : Handle claims to the line Claim Handling Standards, Follow and apply ACG Claim policies, procedures and guidelines, Work within assigned ACG Claim systems including basic PC software, Perform basic 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 visit repair facilities, homes (for inspections), patients, etc., Research, analyze, and interpret subrogation laws in various states, Travel outside of assigned territory which may involve overnight stay, Relocate, work evenings or weekends, Strong negotiating skills.

Preferred Qualifications :