medical claims representative

Edwards Health Care Services, Inc.

<div>GEMCORE&rsquo;s continued success has earned us national recognition with Inc. Magazine&rsquo;s list of America&rsquo;s Fastest-Growing Companies and with the Cleveland Plain Dealer as a Top Workplace six years running! GEMCORE is a rapidly growing multi-state family of companies headquartered in Hudson, OH.
Are you looking to begin or further your career in the medical supply industry where you are able to contribute to the success of the business, and build lasting relationships? All while allowing for personal time every evening, weekend, and holiday? Edwards Health Care Services (EHCS), a division of GEMCORE, is a well-established and growing national direct-to home medical supply provider. We are seeking a highly motivated Medical Claims Representative to join our high energy team. The Medical Claims Representative's primary role is to determine the root cause of denials and payment delays.<ul><li>
We are a fast-growing company with advancement opportunities!</li><li>
This position offers the ability to work unique problems and to apply complex problem solving skills.</li><li>
This is a full-time, non-exempt, position.</li><li>
Once training is complete, this position will potentially be part of a hybrid remote work schedule. This position is located in Hudson, OH.</li><li>
Schedule is 8:00 am - 4:45 pm, Monday through Friday.</li><li>
Employer paid vacation.</li><li>
Benefits available include medical/dental/vision, life, short and long-term disability insurances, and 401K Retirement Savings Plan.</li></ul>
Key Responsibilities<ul><li>
Analyze reports on insurance payment differences, appeals and rebills.</li><li>
Work claim denials.</li><li>
Identify denial trends and suggest process improvements.</li><li>
Collaborate with claims team and communicate effectively with all other department managers in solving issues and implementing new procedures.</li><li>
Proficient in the knowledge of healthcare products, deductibles, co-payments and third-party reimbursement for customer education and employee training purposes.</li></ul> 
Key requirements:<ul><li>
Self-starter with the ability to work independently to achieve desired results.</li><li>
Clinical background or medical terminology knowledge helpful but not necessary.</li><li>
Demonstrated proficiency in Microsoft Outlook and Excel with 30 WPM typing skills.</li><li>
Strong organizational skills and multitasking ability.</li><li>
Excellent telephone skills required.</li><li>
Good cognitive reasoning ability.</li><li>
Detailed and thorough work orientation.</li><li>
Minimum 1-2 years of experience in a consumer service organization or healthcare environment.</li></ul>
Education/Experience<ul><li>
High School Diploma or GED Equivalent</li></ul>
About Edwards Health Care Services, Inc.
Edwards Health Care Services, Inc. (EHCS) is a national direct-to home medical supply provider of high quality medical and diabetes products that support the needs of individuals with diabetes and other conditions. For over 25 years, EHCS have been lighting the way to better health by providing customers an easier way to have products delivered directly to their door. By partnering with healthcare professionals, product manufacturers, and a large network of government and private insurers, EHCS prides itself on personalized customer service and a simplified, seamless order process for every customer&hellip;every time! For more information, visit www.myehcs.com.
About GEMCORE
GEMCORE, a family of companies headquartered in Hudson, Ohio - Edwards Health Care Services, GEMCO Medical, GemCare Wellness, and GEM Edwards Pharmacy - offers a core set of healthcare solutions by partnering with manufacturers, providers, employer groups, insurance groups, and patients to deliver high quality healthcare products and innovative services to proactively better lives. For more information, visit www.gemcorehealth.com.</div>

Medical Claims Representative

Surgery Ventures

<div>Do you have the career opportunities as a Medical Insurance Claims Representative you want with your current employer? We have an exciting opportunity for you to join Surgery Ventures at our Jacksonville Central Billing Office which is part of the nation's leading provider of healthcare services, HCA Healthcare.<h5 class="jobSectionHeader">
Job Summary and Qualifications</h5>
As the Medical Insurance Collections Specialist, you will contribute to the company&rsquo;s mission, vision, and values by completing follow-up and collections for patient services. Under the supervision of the Business Office Manager/Business Office Supervisor, you will obtain payment from third party payers and self-pay accounts to enhance cash flow and gather reimbursement based on established contracts.
What you will do in this role:<ul><li>
You will perform follow up activities on accounts to ensure prompt payment</li><li>
You will identify coding or billing errors from EOBs and work to correct them</li><li>
You will monitor insurance claims and contact insurance companies to resolve claims
</li><li>You will update the patient account record to identify actions taken</li><li>
You will assign bad debt accounts to the collection agency
</li><li>You will act as a liaison and administer contracts in collection of third party accounts (Medicare and Medicaid)</li><li>
You will complete account reconciliation of accounts turned over to outside agencies</li><li>
You will negotiate payment plans on self-pay accounts
</li><li>You are responsible for maintaining accounts receivable and creating a reduction in bad debt
</li></ul>Qualifications you will need:<ul><li>
Minimum (1) year of experience in a medical office setting highly preferred. (i.e. ambulatory surgery center, hospital, doctors office, CBO) preferred</li><li>
Knowledge of managed care payers and medical terminology is preferred</li></ul>
<h5 class="jobSectionHeader">Benefits</h5>
Surgery Ventures offers a total rewards package that supports the health, life, career and retirement of our colleagues. The available plans and programs include:<ul><li>
Comprehensive benefits for medical, prescription drug, dental, vision, behavioral health and telemedicine services</li><li>
Wellbeing support, including free counseling and referral services</li><li>
Time away from work programs for paid time off, paid family leave, long- and short-term disability coverage and leaves of absence</li><li>
Savings and retirement resources, including a 401(k) Plan with a 100% match on 3% to 9% of pay (based on years of service), Employee Stock Purchase Plan, flexible spending accounts, preferred banking partnerships, retirement readiness tools, rollover support and financial wellbeing counseling</li><li>
Education support through tuition assistance, student loan assistance, certification support, dependent scholarships and a partnership with Galen College of Nursing</li><li>
Additional benefits for fertility and family building, adoption assistance, life insurance, supplemental health protection plans, auto and home insurance, legal counseling, identity theft protection and consumer discounts</li></ul>
Learn more about Employee Benefits
Note: Eligibility for benefits may vary by location.
Consider a fulfilling and secure career with Surgery Ventures, in partnership with HCA Healthcare. Our team of over 3,400 physicians manages more than 150 surgery centers across 16 states in the United States. As a dedicated unit within HCA Healthcare, we prioritize providing safe, efficient, and premium surgical services. With over 30 years of pioneering experience in the industry, our physician partners offer exceptional outpatient care to over 800,000 patients in communities across our network. We do so with the backing of the clinical, operational, and financial expertise of a Fortune 100 healthcare leader. At Surgery Ventures, we are committed to supporting your career growth and advancement at every stage.
HCA Healthcare has been recognized as one of the World&rsquo;s Most Ethical Companies&reg; by the Ethisphere Institute more than ten times. In recent years, HCA Healthcare spent an estimated $3.7 billion in cost for the delivery of charitable care, uninsured discounts, and other uncompensated expenses
&quot;Bricks and mortar do not make a hospital. People do.&quot;- Dr. Thomas Frist, Sr. 
HCA Healthcare Co-Founder
If you are looking for an opportunity that provides satisfaction and personal growth, we encourage you to apply for our Medical Insurance Claims Representative opening. We promptly review all applications. Highly qualified candidates will be contacted for interviews. Unlock the possibilities and apply today!
We are an equal opportunity employer. We do not discriminate on the basis of race, religion, color, national origin, gender, sexual orientation, age, marital status, veteran status, or disability status.</div>

Medical Insurance Claims Representative

Risk Theory

<div>
 
 Auto Claims Representative - Dealer Open Lot
 
 
 
 We are an industry claims service leader, providing custom-tailored Third-Party Administration (TPA) programs to clients. We are a national program that is fast-paced and growing. This position handles 1st party Damages to the auto dealer&rsquo;s Inventory and other first-party auto damage claims. As the adjuster in this role, you will handle the claim from the first notice of loss through resolution/settlement and the payment process.
 
 
 Compensation: $60,000 - $90,000 yearly
</div>

Auto Claims Representative

Sedgwick

<div>By joining Sedgwick, you'll be part of something truly meaningful. It&rsquo;s what our 33,000 colleagues do every day for people around the world who are facing the unexpected. We invite you to grow your career with us, experience our caring culture, and enjoy work-life balance. Here, there&rsquo;s no limit to what you can achieve.
Newsweek Recognizes Sedgwick as America&rsquo;s Greatest Workplaces National Top Companies
Certified as a Great Place to Work&reg;
Fortune Best Workplaces in Financial Services &amp; Insurance
Claims Representative - Liability (REMOTE - GL/BI experience)
<div>Are you looking for an opportunity to join a global industry leader where you can bring your big ideas to help solve problems for some of the world&rsquo;s best brands?
<ul><li>Apply your knowledge and experience to adjudicate complex customer claims in the context of an energetic culture.
</li><li>Deliver innovative customer-facing solutions to clients who represent virtually every industry and comprise some of the world&rsquo;s most respected organizations.
</li><li>Be a part of a rapidly growing, industry-leading global company known for its excellence and customer service.
</li><li>Leverage Sedgwick&rsquo;s broad, global network of experts to both learn from and to share your insights.
</li><li>Take advantage of a variety of professional development opportunities that help you perform your best work and grow your career.
</li><li>Enjoy flexibility and autonomy in your daily work, your location, and your career path.
</li><li>Access diverse and comprehensive benefits to take care of your mental, physical, financial and professional needs.
</li></ul>ARE YOU AN IDEAL CANDIDATE? We are looking for driven individuals that embody our caring counts model and core values that include empathy, accountability, collaboration, growth, and inclusion.
PRIMARY PURPOSE : To process low level general liability claims to determine benefits due; to ensure ongoing adjudication of claims within company standards and industry best practices; and to identify subrogation of claims and negotiate settlements with general supervision.
ESSENTIAL FUNCTIONS and RESPONSIBILITIES
<ul><li>Processes low level general liability claims by gathering information to determine liability exposure; assigns reserve values to claims, making claims payments as necessary, and settling claims up to designated authority level.
</li><li>Develops and coordinates low level general liability claims' action plans to resolution, return-to-work efforts, and approves claim payments.
</li><li>Approves and processes assigned claims, determines benefits due, and administers action plan pursuant to the claim or client contract.
</li><li>Administers subrogation of claims and negotiates settlements.
</li><li>Communicates claim action with claimant and client.
</li></ul>ADDITIONAL FUNCTIONS and RESPONSIBILITIES
<ul><li>Performs other duties as assigned.
</li><li>Supports the organization's quality program(s).
</li><li>Travels as required.
</li></ul>QUALIFICATIONS
Education &amp; Licensing
Bachelor's degree from an accredited college or university preferred.
Experience :
Two (2) years of Liability claims management experience or equivalent combination of education and experience required.
TAKING CARE OF YOU
<ul><li>Flexible work schedule.
</li><li>Referral incentive program.
</li><li>Career development and promotional growth opportunities.
</li><li>A diverse and comprehensive benefits offering including medical, dental vision, 401K on day one.
</li></ul>The statements contained in this document are intended to describe the general nature and level of work being performed by a colleague assigned to this description. They are not intended to constitute a comprehensive list of functions, duties, or local variances. Management retains the discretion to add or to change the duties of the position at any time
</div>Sedgwick is an Equal Opportunity Employer and a Drug-Free Workplace.
<h2 class="jobSectionHeader">If you're excited about this role but your experience doesn't align perfectly with every qualification in the job description, consider applying for it anyway! Sedgwick is building a diverse, equitable, and inclusive workplace and recognizes that each person possesses a unique combination of skills, knowledge, and experience. You may be just the right candidate for this or other roles.</h2></div>

Claims Representative - Liability (REMOTE - GL/BI experience)

Nodak Insurance Company

<div><div><div>Summary: We are seeking a detail-oriented Inside Liability Claims Representative to investigate, evaluate, negotiate, and settle complex liability claims within assigned authority. This position plays a key role in providing prompt, professional claim service while maintaining strong relationships with policyholders, agents, attorneys, and others involved in the claim process. 
 
Essential Duties and Responsibilities:</div></div><ul><li><div>
Conduct thorough investigations, gathering statements, medical records, police reports, photographs, and expert testimony as needed.</div></li><li><div>
Analyze coverage and liability issues, interpreting policy language and legal precedent to determine appropriate claim outcomes.</div></li><li><div>
Prepare clear and well-documented claim files, including worksheets, forms, and supporting materials for accurate tracking and follow-up.</div></li><li><div>
Review bills, estimates, and other documentation to ensure accuracy and compliance with policy provisions.</div></li><li><div>
Negotiate fair and timely settlements within authority limits; prepare and present settlement recommendations when additional authority is needed.</div></li><li><div>
Communicate claim decisions and coverage determinations effectively and professionally, including preparing denial documentation when warranted.</div></li><li><div>
Engage external specialists or vendors when necessary to support cost-effective and efficient claim resolution.</div></li></ul><div><div>
Authority: Operate within established company policies and claim-handling procedures, exercising sound judgment, initiative, and independence in decision-making.</div> 
</div><div><div>Education &amp; Experience: Bachelor's Degree or equivalent work experience required. Prior insurance claims handling experience strongly preferred. 
Promotional potential and organizational progressions: Senior Claim Representative. 
 
Required Knowledge and Skills:</div></div><ul><li>
Communication: Excellent verbal and written communication skills; able to explain complex information clearly and handle sensitive interactions with professionalism and empathy.</li><li>
Technical: Proficient in computer systems, data entry, and claims software; strong organizational, time management, and multitasking abilities.</li><li>
Analytical: Ability to interpret policy language, legal principles, and medical documentation accurately.</li><li>
Decision-Making: Strong problem-solving and judgment skills; comfortable interpreting contracts and applying company policy.</li><li>
Mathematical: Competent in basic math concepts for accurate claim calculations.</li>
Reliability: Consistent attendance, punctuality, and accountability. 
<li>
</li></ul><div><div>Special Relationships (to other people, internally and externally, cost control, etc.): Has broader personal settlement authority subject to normal supervisory review. Generally, can work independently with normal supervision and accountability for results. Has considerable contact by telephone or in person with claimants, insureds, agents, attorneys, Company personnel, and the general public. Must continually be aware of being a Company representative and 
projecting a favorable image. Must have the ability to communicate effectively with upset, angry individuals to resolve disputes and disagreements.</div> 
</div><div><div>Physical Requirements: Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. While performing the duties of this job, the employee is occasionally required to stand, walk, sit, use hands to finger, handle, or feel, reach with hands and arms, climb or balance; stoop, kneel, crouch, or crawl; and talk or hear. The employee must may occasionally lift and/or move up to 25 pounds. The noise level in the work environment is usually moderate.</div></div><div><div>
Nodak Insurance Company complies fully with all federal, state, and local employment laws and shall provide equal employment and advancement opportunities for all persons regardless of race, color, creed, religion, national origin, sex, sexual orientation, age, the presence of any mental or physical disability, status with regard to public assistance or marriage, or any other category protected by local, state or federal law.</div></div></div>

Inside Claims Representative

AAA The Auto Club Group

<div>It&rsquo;s a great time to join AAA The Auto Club Group!
JOIN THE TEAM COMMITTED TO DRIVING YOUR CAREER FORWARD
Job Type:
Full time 
<div><div>Exempt/Non Exempt: 
</div></div>Salary
Job Description: 
 
 
***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. ***
<h2 class="jobSectionHeader">APD Claim Representative II (Michigan) &ndash; The Auto Club Group
</h2>Reports to: APD Claim Manager I
What you will do: (Primary Duties &amp; Responsibilities)
<h2 class="jobSectionHeader">The Auto Club Group is seeking an Auto Claim Representative II who works 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.
</h2><h2 class="jobSectionHeader">In this position, you will have the opportunity to:
</h2>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 Auto Physical Damage (&ldquo;APD&rdquo;) 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.
Supervisory Responsibilities (briefly describe, if applicable, or indicate None):
None
<h2 class="jobSectionHeader">How you will benefit :
</h2><h2 class="jobSectionHeader">Claim Representative II will earn a competitive salary of $54,643.68- $78,000 annually with annual bonus potential based on performance.
</h2><h2 class="jobSectionHeader">Excellent and comprehensive benefits packages are just another reason to work for the Auto Club Group. Benefits include:
</h2><ul><li><h2 class="jobSectionHeader">401k Match
</h2></li><li><h2 class="jobSectionHeader">Medical
</h2></li><li><h2 class="jobSectionHeader">Dental
</h2></li><li><h2 class="jobSectionHeader">Vision
</h2></li><li><h2 class="jobSectionHeader">PTO
</h2></li><li><h2 class="jobSectionHeader">Paid Holidays
</h2></li><li><h2 class="jobSectionHeader">Tuition Reimbursement
</h2></li></ul>II. Required Qualifications (these are the minimum requirements to qualify)
Education (include minimum education and any licensing/certifications):
<ul><li>Complete ACG Claim Representative Training Program or demonstrate equivalent knowledge or experience
</li><li>In states where an Adjuster&rsquo;s license is required, the candidate must be eligible to acquire a State Adjuster&rsquo;s license within 90 days of hire and maintain as specified for appropriate states.
</li><li>A valid driver's license is required if the primary responsibilities of the role involve conducting in-person inspections or frequent in-person meetings with members
</li></ul>Experience:
<ul><li>One year of experience with:
</li></ul><ul><li>negotiating claim settlements
</li></ul><ul><li>securing and evaluating evidence
</li></ul><ul><li>preparing manual and electronic estimates
</li></ul><ul><li>subrogation claims, including identifying recovery opportunities
</li></ul><ul><li>resolving coverage questions
</li><li>taking statements
</li><li>establishing clear evaluation and resolution plans for claims
</li></ul>Knowledge and Skills:
Knowledge of:
<ul><li>Essential Insurance Act (Michigan)
</li><li>Fair Trade Practices Act as it relates to claims
</li><li>subrogation procedures and processes
</li><li>intercompany arbitration/dispute resolution
</li><li>Negligence Laws and Statutes
</li><li>No-Fault Law and No-Fault Reform
</li><li>Collision repair techniques
</li></ul>Ability to:
<ul><li>handle claims to the line Claim Handling Standards
</li><li>follow and apply ACG Claim policies, procedures and guidelines
</li></ul><ul><li>work within assigned ACG Claim systems including basic PC software
</li><li>perform basic claim file review and investigations
</li><li>demonstrate effective communication skills (verbal and written)
</li><li>demonstrate customer service skills by building and maintaining relationships with insureds/claimants while exhibiting understanding of their problems and responding to questions and concerns
</li><li>analyze and solve problems while demonstrating sound decision making skills
</li><li>prioritize claim related functions
</li><li>process time sensitive data and information from multiple sources
</li><li>manage time, organize and plan workload and responsibilities
</li><li>safely operate a motor vehicle in order to visit repair facilities, homes (for inspections), patients, etc.
</li><li>research analyze and interpret subrogation laws in various states
</li><li>travel outside of assigned territory which may involve overnight stay
</li><li>relocate, work evenings or weekends
</li><li>strong negotiating skills
</li></ul>III. Preferred Qualifications
Education:
<ul><li>Associate degree in Business Administration, Insurance or a related field or the equivalent in related work experience
</li><li>Completion of the Insurance Institute of America's: General Insurance Program, Associate in Claims, Associate in Management or equivalent
</li><li>CPCU coursework or designation
</li><li>I-Car 2000 training
</li><li>CCC training
</li><li>Xactware Training
</li></ul>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.
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&rsquo;s journey through insurance, travel, financial services, and roadside assistance.
And when you join our team, one of the first things you&rsquo;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
Important Note:
ACG&rsquo;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 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.</div>

APD Claim Representative II - Michigan

<div>It&rsquo;s a great time to join AAA The Auto Club Group!
JOIN THE TEAM COMMITTED TO DRIVING YOUR CAREER FORWARD
Job Type:
Full time 
<div><div>Exempt/Non Exempt: 
</div></div>Salary
Job Description: 
 
 
***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. ***
<h2 class="jobSectionHeader">APD Claim Representative II (Regional)&ndash; The Auto Club Group
</h2>Reports to: APD Claim Manager I
What you will do: (Primary Duties &amp; Responsibilities)
<h2 class="jobSectionHeader">The Auto Club Group is seeking an Auto Claim Representative II who works 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.
</h2><h2 class="jobSectionHeader">In this position, you will have the opportunity to:
</h2>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 Auto Physical Damage (&ldquo;APD&rdquo;) 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.
Supervisory Responsibilities (briefly describe, if applicable, or indicate None):
None
<h2 class="jobSectionHeader">How you will benefit :
</h2><h2 class="jobSectionHeader">Claim Representative II will earn a competitive salary of $59,134.30- $79,000 annually with annual bonus potential based on performance.
</h2><h2 class="jobSectionHeader">Excellent and comprehensive benefits packages are just another reason to work for the Auto Club Group. Benefits include:
</h2><ul><li><h2 class="jobSectionHeader">401k Match
</h2></li><li><h2 class="jobSectionHeader">Medical
</h2></li><li><h2 class="jobSectionHeader">Dental
</h2></li><li><h2 class="jobSectionHeader">Vision
</h2></li><li><h2 class="jobSectionHeader">PTO
</h2></li><li><h2 class="jobSectionHeader">Paid Holidays
</h2></li><li><h2 class="jobSectionHeader">Tuition Reimbursement
</h2></li></ul>II. Required Qualifications (these are the minimum requirements to qualify)
Education (include minimum education and any licensing/certifications):
<ul><li>Complete ACG Claim Representative Training Program or demonstrate equivalent knowledge or experience
</li><li>In states where an Adjuster&rsquo;s license is required, the candidate must be eligible to acquire a State Adjuster&rsquo;s license within 90 days of hire and maintain as specified for appropriate states.
</li><li>A valid driver's license is required if the primary responsibilities of the role involve conducting in-person inspections or frequent in-person meetings with members
</li></ul>Experience:
<ul><li>One year of experience with:
</li></ul><ul><li>negotiating claim settlements
</li></ul><ul><li>securing and evaluating evidence
</li></ul><ul><li>preparing manual and electronic estimates
</li></ul><ul><li>subrogation claims, including identifying recovery opportunities
</li></ul><ul><li>resolving coverage questions
</li><li>taking statements
</li><li>establishing clear evaluation and resolution plans for claims
</li></ul>Knowledge and Skills:
Knowledge of:
<ul><li>Essential Insurance Act (Michigan)
</li><li>Fair Trade Practices Act as it relates to claims
</li><li>subrogation procedures and processes
</li><li>intercompany arbitration/dispute resolution
</li><li>Negligence Laws and Statutes
</li><li>No-Fault Law and No-Fault Reform
</li><li>Collision repair techniques
</li></ul>Ability to:
<ul><li>handle claims to the line Claim Handling Standards
</li><li>follow and apply ACG Claim policies, procedures and guidelines
</li></ul><ul><li>work within assigned ACG Claim systems including basic PC software
</li><li>perform basic claim file review and investigations
</li><li>demonstrate effective communication skills (verbal and written)
</li><li>demonstrate customer service skills by building and maintaining relationships with insureds/claimants while exhibiting understanding of their problems and responding to questions and concerns
</li><li>analyze and solve problems while demonstrating sound decision making skills
</li><li>prioritize claim related functions
</li><li>process time sensitive data and information from multiple sources
</li><li>manage time, organize and plan workload and responsibilities
</li><li>safely operate a motor vehicle in order to visit repair facilities, homes (for inspections), patients, etc.
</li><li>research analyze and interpret subrogation laws in various states
</li><li>travel outside of assigned territory which may involve overnight stay
</li><li>relocate, work evenings or weekends
</li><li>strong negotiating skills
</li></ul>III. Preferred Qualifications
Education:
<ul><li>Associate degree in Business Administration, Insurance or a related field or the equivalent in related work experience
</li><li>Completion of the Insurance Institute of America's: General Insurance Program, Associate in Claims, Associate in Management or equivalent
</li><li>CPCU coursework or designation
</li><li>I-Car 2000 training
</li><li>CCC training
</li><li>Xactware Training
</li></ul>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.
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&rsquo;s journey through insurance, travel, financial services, and roadside assistance.
And when you join our team, one of the first things you&rsquo;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
Important Note:
ACG&rsquo;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 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.</div>

Regional Auto Claim Representative II (Desk)

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