Sr Claim Specialist - Medical Management Unit

Company: The Auto Club Group
Location: Milwaukee
Posted on: May 7, 2025

Job Description:

It's a great time to join AAA The Auto Club Group!JOIN THE TEAM COMMITTED TO DRIVING YOUR CAREER FORWARDJob Type:Full timeExempt/Non Exempt:SalaryJob Description:Sr Claim Specialist - Medical Management Unit- The Auto Club GroupWhat you will do:The Auto Club Group is seeking prospectiveSeniorClaim Specialistswho canwork 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:* 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.* 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, physicians' offices and medical insurance carriers to obtain necessary information to complete the claims review process and make the appropriate determinations.Work EnvironmentThis 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.With our powerful brand and the mentoring we offer, you will find your position as aSeniorClaim Specialistcan lead to a rewarding career at our growing organization.How you will benefit:Senior Claim Specialists will earn a competitive salary of $75,000 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:o 401k Matcho Medicalo Dentalo Visiono PTOo Paid Holidayso Tuition ReimbursementWe're looking for candidates who:Preferred QualificationsEducation:* 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 designationRequired Qualifications (these are the minimum requirements to qualify): Education:* 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 LicenseExperience:Five years of experience in the following:* Negotiation of complex Michigan claim settlements* Securing and evaluating evidence* Preparing manual and electronic estimates* Subrogation claims* Resolving complex coverage questions* Taking statements* Establishing clear evaluation and resolution plans for claimsKnowledge and Skills:Advanced technical knowledge of * Essential Insurance Act (Michigan)* Fair Trade Practices Act as it relates to claims* Subrogation procedures and processes* Intercompany arbitration* LitigationAdvanced technical knowledge of:* Negligence Law* No-Fault Law* Medical terminology and human anatomy* MCCA and attorney represented claimsAbility 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 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 attend meetings off site * Travel outside of assigned territory which may involve overnight stay* Relocate, work evenings or weekends#AppcastImportant 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 AreBecome 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 Important Note:ACG's Compensation philosophy is to provide a market-competitive structure of fair, equitable and performance-based pay to attract and retain excellent talent that will enable ACG to meet its short and long-term goals. ACG utilizes a geographic pay differential as part of the base salary compensation program. Pay ranges outlined in this posting are based on the various ranges within the geographic areas which ACG operates. Salary at time of offer is determined based on these and other factors as associated with the job and job level.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.The Auto Club Group, and all its affiliated companies, is an equal opportunity/affirmative action employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, gender identity, sexual orientation, national origin, disability or protected veteran status.Regular and reliable attendance is essential for the function of this job.AAA The Auto Club Group is committed to providing a safe workplace. Every applicant offered employment within The Auto Club Group will be required to consent to a background and drug screen based on the requirements of the position.

Keywords: The Auto Club Group, DeKalb , Sr Claim Specialist - Medical Management Unit, Executive , Milwaukee, Illinois