Claims Senior MedPay Adjuster

AAA Auto Club Enterprises; Lincoln (RI); On-site; USD 50,000 - 66,000; Full time

Benefits offered by this job

Health coverage

401(k) + Pension

Tuition assistance

Floating holidays

Parental leave

Wellness programs

Employee discounts

Job summary

Auto Club Enterprises is seeking a Claims Senior Medpay Adjuster to handle moderate to high complexity auto claims, including liability evaluation, coverage interpretation, and negotiation. The role requires independent judgment to ensure compliance with state and federal laws and company guidelines.

Responsibilities include investigations, statements collection, claim value assessment, and supporting the claims process across multiple systems (CACS, HUON, HOC, GUIDEWIRE).

Qualifications

• Bachelor's degree or equivalent combination of education and experience.
• 7-9 years of claims handling experience.
• 7-9 years Property, Auto, Casualty or relevant claims administration experience preferred.
• Knowledge of claims administration best practices and procedures.
• Advanced knowledge of Microsoft Office and claims software.

Responsibilities

• Communicate with insureds and claimants; explain benefits, coverages, fault, and claims process.
• Conduct phone investigations to determine liability and damages; obtain statements.
• Evaluate and determine claim values upon receipt and assessment of data.
• Negotiate within settlement authority to resolve claims.
• Update claim files and reports in company systems (CACS, HUON, HOC, GUIDEWIRE).
• Control expenses for areas of responsibility; coordinate with internal/external departments.
• Independently resolve claim exposures within authority.
• Respond to customer needs and problems; participate in legal proceedings if required.

Skills

Oral & written communication

Leadership

Interpersonal skills

Analytical thinking

Education

Bachelor's degree or equivalent

Tools

CACS

HUON

HOC

Guidewire

Microsoft Office

Job description

Job Summary

The Claims Senior Medpay Adjuster handles moderate to high complexity Auto claims matters 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, and negotiation of moderate to high-complexity claims. Employs discretion and independent judgment to ensure compliance with state and federal law, and with established company, technical, and customer service best practices.

Job Summary

The Claims Senior Medpay Adjuster handles moderate to high complexity Auto claims matters 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, and negotiation of moderate to high-complexity claims. Employs discretion and independent judgment to ensure compliance with state and federal law, and with established company, technical, and customer service best practices.

Job Duties

• Communicate and interact with a variety of individuals including insureds and claimants. Explain benefits, coverages, fault and claims process either verbally or in writing in compliance with regulatory and statutory requirements. Recognize and appropriately address coverage issues.
• Conduct phone investigations to determine liability and damages. Identify and obtain statements from insureds, claimants and witnesses. Verify and resolve coverage by gathering necessary information to ensure policy applicability.
• 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 first and third party claims.
• Update database production reports, document and update claim files via company systems, i.e. CACS, HUON, HOC, GUIDEWIRE, etc.
• Control expenses for areas of responsibility.
• Verify and interpret / resolve coverage by gathering necessary information to ensure policy applicability. Coordinate with internal and external departments as required.
• Independently resolve claim exposures within level of authority.
• Respond quickly to customer needs and problems.
• May attend and participate in legal proceedings.

Qualifications

• Bachelors Equivalent combination of education and experience Preferred
• 7-9 years Prior claims handling experience. Required
• 7-9 years Property, Auto, Casualty or relevant claims administration experience. Preferred
• Comprehensive knowledge of claims administration best practices and procedures.
• Comprehensive knowledge of building and vehicle repair procedures and third-party liability issues.
• Extensive knowledge of insurance, fault assessment, negligence and subrogation principles required.
• 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.
• Valid Driver's License, acceptable Department of Motor Vehicles record and minimum liability insurance - Issued by State Required
• An insurance/claims adjuster license may be required for claims administration in specific states.

Travel Requirements

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

The starting pay range for this position is $35.94 - $47.87 per hour. Additionally, you will be eligible to participate in our incentive program based upon the achievement of organization, team and personal performance.

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