Claims SIU Complex Major Medical Investigator

Claims SIU Complex Major Medical Investigator

Job Summary
The Claims Complex Casualty Adjuster handles complex claims involving material damage, property, and/or liability lines of insurance written by the Interinsurance Exchange in compliance with all regulatory and statutory requirements. The primary functions include liability investigation, coverage evaluation, negotiation strategies and claims resolution of complex claims. Employs discretion and independent judgment to ensure compliance with state and federal law, and with established company, technical, and customer service best practices. Under limited supervision, works within specific limits of authority to resolve claims.

Job Duties

• Conduct phone and/or field investigations to determine liability and damages. May attend and participate in legal proceedings. Identify and obtain statements from insureds, claimants and witnesses.
• Communicate and interact with a variety of individuals including insureds and claimants. Explain benefits, coverages, fault and claims process either verbally or in writing which complies with regulatory and statutory requirements. Recognize and appropriately address complex coverage and subrogation issues.
• Evaluate and determine claim values upon receipt and assessment of property, bodily injury and liability data.
• Negotiate within settlement authority with insureds and claimants to resolve their first and third-party claims.
• Control expenses for areas of responsibility.
• Handle administrative functions, update database production reports, document and update claim files via company systems, i.e. CACS, HUON, HOC, GUIDEWIRE, etc.
• Verify and interpret/resolve coverage by gathering necessary information to ensure policy applicability. Coordinate with internal and external departments as required.
• Mentor other adjusters, assisting them with increasing understanding of adjudicating complex claims.
• Respond quickly to customer needs and problems.
• Independently resolve claim exposures within level of authority.

Qualifications

• Bachelors Equivalent combination of education and experience Preferred
• 7-9 years Property, Auto, Casualty or relevant claims experience. Required
• 10+ years Prior claims experience. Preferred
• Comprehensive knowledge of claims administration best practices and procedures.
• Advanced knowledge of insurance, fault assessment, negligence and subrogation principles.
• Comprehensive understanding of building and vehicle repair procedures and third-party liability issues.
• Advanced knowledge of Microsoft Office suite, general computer software and claims software.
• Advanced organization and planning recognition skills required.
• Advanced oral and written communication skills required.
• Advanced interpersonal skills required.
• Advanced leadership skills among peers required.
• Exhibit proficiency and understanding of medical terminology and causality.
• Valid Driver's License, acceptable Department of Motor Vehicles record and minimum liability insurance - Issued by State Required
• Chartered Property Casualty Underwriter - Insurance Institute of America Preferred
• Associate in Claims - Insurance Institute of America Preferred
• An insurance/claims adjuster license may be required for claims administration in specific states. Preferred

Travel Requirements

• Occasional travel to business meetings or conferences. (5% proficiency)

Remarkable benefits:

•    Health coverage for medical, dental, vision

•    401(K) saving plans with company match AND Pension    

•    Tuition assistance

•    Floating holidays and PTO for community volunteer programs

•    Paid parental leave

•    Wellness programs

•    Employee discounts (membership, insurance,

travel, entertainment, services and more!)

Auto Club Enterprises is the largest club within the national AAA federation. We have nearly 17,000 employees in 24 states helping more than 18 million members. The strength of our organization is our employees. Bringing together and supporting different cultures, backgrounds, personalities, and strengths creates a team capable of delivering legendary, lifetime service to our members. When we embrace our diversity – we win. All of Us! With our national brand recognition, long-standing reputation since 1900, and constantly growing membership, we are seeking career-minded, service-driven professionals to join our team.

"Through dedicated employees we proudly deliver legendary service and beneficial products that provide members peace of mind and value.”

AAA is an Equal Opportunity Employer

Our organization participates in E-Verify