Claim Specialist - Direct Repair Unit

Responsibilities

• 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 process
• Initiating documentation in the claim handling system
• Complete complex coverage analysis
• Ensure all possible policyholder benefits are identified
• Create additional sub-claims if needed
• 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

Requirements

• Required
• Education (including minimum education and any licensing/certifications):
• High school diploma or equivalent
• Complete ACG Claim Representative Training Program or demonstrate equivalent knowledge or experience
• In states where an Adjuster's license is required, the candidate must be eligible to acquire a State Adjuster's license within 90 days of hire and maintain as specified for appropriate state
• Three years of experience or equivalent training in the following:
• negotiation of claim settlements
• securing and evaluating evidence
• preparing manual and electronic estimates
• subrogation claims
• resolving coverage questions
• taking statements
• establishing clear evaluation and resolution plans for claims
• handle claims to the line Claim Handling Standards
• follow and apply ACG Claim policies, procedures and guidelines
• work within assigned ACG Claim systems including basic PC software
• perform basic claim file review and investigations
• demonstrate effective communication skills (verbal and written)
• demonstrate customer service skills by building and maintaining relationships with insured/claimants while exhibiting understanding of their problems and responding to questions and concerns
• analyze and solve problems while demonstrating sound decision-making skills
• prioritize claim related functions
• process time sensitive data and information from multiple sources
• manage time, organize and plan workload and responsibilities
• safely operate a motor vehicle in order to visit repair facilities, homes (for inspections), patients, etc.
• research analyze and interpret subrogation laws in various states
• travel outside of assigned territory which may involve overnight stay
• relocate, work evenings or weekends
• Preferred
• Education:
• Associate degree in Business Administration, Insurance or a related field or the equivalent in related work experience
• Completion of the Insurance Institute of America's: General Insurance Program, Associate in Claims, associate in management or equivalent
• CPCU coursework or designation
• I-Car ProLevel training
• CCC training
• XACT ware Training
• Knowledge of:
• Advanced knowledge of:
• Essential Insurance Act (Michigan)
• Fair Trade Practices Act as it relates to claims
• subrogation procedures and processes
• intercompany arbitration
• handling simple litigation
• Negligence Law
• No-Fault Law
• collision repair techniques
• Work Environment:
• This

Benefits

Additional Information

Job Type: Full time Exempt/Non Exempt: Salary Job Description: Location Details: Remote Position Schedule / Shift: Monday-Friday 8am-5pm ET Position Summary: The Auto Club Group is seeking a highly skilled Direct Repair Claim Specialist to manage complex physical damage claims with minimal supervision. This role operates with a high level of approval authority and requires advanced technical expertise to investigate, evaluate, and resolve challenging claims scenarios. The specialist serves as a key decision-maker, ensuring accurate loss assessment, adherence to company guidelines, and timely claim resolution while delivering exceptional service to members and repair partners.

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