Claims Senior MedPay Adjuster

Auto Club Of Southern Calif; Lincoln (RI); On-site; USD 50,000 - 66,000; Full time

Benefits offered by this job

Health coverage for medical, dental, &

401(K) plus Pension

Tuition assistance

Floating holidays & PTO

Paid parental leave

Wellness programs

Employee discounts

Job summary

Auto Club Enterprises seeks a Claims Senior Medpay Adjuster to handle moderate to high complexity Auto claims including material damage, property, and liability lines. You will lead liability investigations, evaluate coverages, and negotiate settlements within authority while ensuring regulatory compliance.

Responsibilities include interviewing insureds and witnesses, obtaining statements, and maintaining accurate claim files across systems (CACS, HUON, HOC, GUIDEWIRE).

Qualifications

• Bachelor's degree or equivalent combination of education and experience preferred.
• 7-9 years prior claims handling experience required.
• Knowledge of property, auto, casualty or relevant claims administration.
• Advanced knowledge of claims software and Microsoft Office.
• Valid driver's license and insurability requirements.

Responsibilities

• Communicate and interact with insureds and claimants to explain benefits, coverages, fault and claims process in compliance with regulations.
• Conduct phone investigations to determine liability and damages and obtain statements from insureds, claimants and witnesses.
• Verify and resolve coverage by gathering information to ensure policy applicability.
• Evaluate and determine claim values on property, bodily injury and liability data.
• Negotiate within settlement authority to resolve first and third party claims.
• Update and maintain claim files in company systems (CACS, HUON, HOC, GUIDEWIRE) and generate production reports.
• Control expenses for areas of responsibility and ensure policy applicability.
• Independently resolve claim exposures within level of authority and respond to customer needs.
• May attend and participate in legal proceedings.

Skills

Claims handling

Negotiation

Communication skills

Attention to detail

Microsoft Office

Education

Bachelor's degree-equivalent

Tools

CACS

HUON

HOC

GUIDEWIRE

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 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)

Remuneration

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!)

About Auto Club Enterprises

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."

Equal Opportunity

AAA is an Equal Opportunity Employer

Verification

Our organization participates in E-Verify