Claims MedPay Adjuster - Medicare Specialist

Claims MedPay Adjuster - Medicare Specialist

Job Summary

This position supports the Auto Claims Operation by providing service pursuant to the policy by handling claims of 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 low to moderate-complexity claims in compliance with established company technical and customer service Best Practices. Under general direction, works within specific limits of authority.

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 common coverage issues.

• Conduct phone investigations to determine liability and damages. Identify and obtain statements from insureds, claimants and witnesses. Verify and interpret/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 their first and third party claims.

• Handle administrative functions, update database production reports, document and update claim files via company systems, i.e. CACS, HUON, HOC, GUIDEWIRE, etc.

• Coordinate with internal and external departments as required.

• May attend and participate in legal proceedings.

• Respond quickly to customer needs and problems.

Qualifications

• Bachelors Equivalent combination of education and experience Preferred

• 4-6 years Prior claims handling experience. Required

• 4-6 years Property or Casualty claims administration experience. Preferred

• Comprehensive knowledge of claims administration best practices and procedures.

• Moderate understanding of building and vehicle repair practices.

• Comprehensive knowledge of insurance, fault assessment, negligence and subrogation principles.

• Comprehensive 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.

• 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.

The starting pay range for this position is:

$27.27 - $40.37

Additionally, for full time positions, you will be eligible to participate in our incentive program based upon the achievement of organization, team and personal performance.

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Remarkable benefits:
•    Health coverage for medical, dental, vision
•    401(K) saving plan with company match AND Pension
•    Tuition assistance
•    PTO for community volunteer programs
•    Wellness program
•    Employee discounts

Auto Club Enterprises is the largest federation of AAA clubs in the nation. We have 14,000 employees in 21 states helping 17 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 1902, 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

The Automobile Club of Southern California will consider for employment all qualified applicants, including those with criminal histories, in a manner consistent with the requirements of applicable federal, state, and local laws, including the City of Los Angeles’ Fair Chance Initiative for Hiring Ordinance (FCIHO), the Unincorporated Los Angeles County (ULAC) regulation, and the California Fair Chance Act (CFCA).