APD Claim Rep II

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Job Type:

Job Description:

Reports to (job title): Claim Manager as appropriate

I.  Position Description

Post for All Units:

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.

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.

Additional Items to Post for Auto Physical Damage (“APD”) Units Only:

Employees assigned to Auto Physical Damage (“APD”) claim unit will handle moderately complex claims involving settling Total Losses, inspecting vehicles and preparing estimates of damage. If in the DRS Examiner role, manage Direct Repair Shops for compliance with our program. Additional responsibilities may include the following:  determining cause of damage, establishing liability, identifying subrogation potential, monitoring repairs and approving car rental expense.  May handle simple APD Litigation cases.

Additional Items to Post for Liability/Bodily Injury/Med Pay/MRTS/Non-MI PIP Units Only:

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.

Additional Items to Post for Michigan Personal Injury Protection (“PIP”) Units Only:

Employees assigned to PIP claim unit are responsible for Michigan PIP Fast Track claims involving minor injuries.  Claims will include emergency room treatment and release, primary care physician treatment, and injuries requiring very little follow-up care.  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.

Additional Items to Post for Homeowners and Homeowners CAT Units Only:

Employees assigned to Homeowner/CAT claim unit will handle claims generally valued between $5,000 and $25,000 (for the inside desk role) and up to $100,000 (for field role). Investigate claims requiring coverage analysis.  When handling claims in the field, must prepare damage estimates using claims software.  Review estimates for accuracy.   May monitor contractor repair status and updates.  

Additional Items to Post for Recovery Units Only:

Employees assigned to a Recovery unit will complete moderately complex recovery tasks on  claims for all lines of business.  The tasks may not cover the entire lifecycle of a claim but will be an expansion of those aspects related to the financial recovery of funds previously paid on a claim from liable parties or other insurance carriers. Additional responsibilities may include the following:  evaluating and presenting proofs to support both liability and damage decisions; applying knowledge of venues, negligence laws and case law associated with recovery for all states to determine handling strategies; participating in the arbitration process as an applicant, respondent-counter applicant and as an arbitrator rendering decisions on cases presented to Arbitration Forums; negotiating, settling and recovering receipts; ensuring that funds recovered are accounted for appropriately and settlements are maximized.

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

None

II. Required Qualifications (these are the minimum requirements to qualify)

Education (include minimum education and any licensing/certifications):

Post for All Claim Units:

• Complete ACG Claim Representative 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 as specified for appropriate states.
• Must have a valid State Driver's License

Experience:

Post for All Claim Units:

• 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 and Skills:

Post for All Claim Units:

Knowledge of:

• Essential Insurance Act (Michigan)
• Fair Trade Practices Act as it relates to claims
• subrogation procedures and processes
• intercompany arbitration/dispute resolution

Additional Items to Post for APD Units Only:

Knowledge of:

• Negligence Laws and Statutes
• No-Fault Law and No Fault Reform
• collision repair techniques

Additional Items to Post for Liability, Bodily Injury, Med Pay, MRTS, Non-MI Personal Injury Protection (“PIP”) and Michigan PIP Units Only:

Knowledge of:

• Negligence Law
• No-Fault Law
• medical terminology and human anatomy

Additional Items to Post for Homeowners and Homeowners CAT Units Only:

Knowledge of:

• knowledge of building construction and repair techniques

Ability to:

Post for All Claim Units:

• 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 work load 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

III. Preferred Qualifications

Education:

• 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
• I-Car 2000 training
• CCC training
• Xactware Training

Post for Homeowners/CAT Units Only:

Ability to:

• lift up to 25 pounds
• climb ladders
• walk on roofs

Post for Recovery Unit Only

• Certified arbitrator
• Experience filing and hearing arbitration cases
• Advanced negotiations training

IV. Work Environment

Works in a temperature controlled office environment.  Depending on line frequent travel may be required to various repair facilities in order to conduct inspections/re-inspections, visit patients, hospitals, attorneys, rehabilitation centers, repair facilities, etc. per with exposure to road hazards and temperature extremes. For Homeowners and CAT may require deployment to territories impacted by storms.

Important Note: THE ABOVE STATEMENTS DESCRIBE THE PRINCIPAL AND ESSENTIAL FUNCTIONS, BUT NOT ALL FUNCTIONS THAT MAY BE INHERENT IN THE JOB. THIS JOB REQUIRES THE ABILITY TO PERFORM DUTIES CONTAINED IN THE JOB DESCRIPTION FOR THIS POSITION, INCLUDING, BUT NOT LIMITED TO, THE ABOVE REQUIREMENTS.  REASONABLE ACCOMMODATIONS WILL BE MADE FOR OTHERWISE QUALIFIED APPLICANTS, AS NEEDED, TO ENABLE THEM TO FULFILL THESE REQUIREMENTS. 

Who We Are

Become a part of something bigger.

The Auto Club Group (ACG) provides membership, travel, insurance, and financial service offerings to approximately 14+ million members and customers across 14 states and 2 U.S. territories through AAA, Meemic, and Fremont brands. ACG belongs to the national AAA federation and is the second largest AAA club in North America.

By continuing to invest in more advanced technology, pursuing innovative products, and hiring a highly skilled workforce, AAA continues to build upon its heritage of providing quality service and helping our members enjoy life’s journey through insurance, travel, financial services, and roadside assistance.

And when you join our team, one of the first things you’ll notice is that same, whole-hearted, enthusiastic advocacy for each other.

We have positions available for every walk of life! AAA prides itself on creating an inclusive and welcoming environment of diverse backgrounds, experiences, and viewpoints, realizing our differences make us stronger.

To learn more about AAA The Auto Club Group visit www.aaa.com