Claims Examiner
The person in this role works directly with Claims management to communicate trends and patterns on coverage, high severity and complex claims. This individual provides guidance to management for the handling, strategy, and resolution of claims, including providing authority for settlement.
Duties/Responsibilities:
- Reviews and authorizes claim reserves and provides settlement recommendations. Provides direction to claims personnel and counsel on complex claims files.
- Reviews claim files to ensure completeness, timeliness and member service guidelines are being adhered to for compliance.
- Provides management with recommendations and guidance regarding coverage to ensure the Exchange is protected against risk.
- Ensures accurate diaries are established and maintained and provides guidance in litigation strategy to monitor expenses.
- Analyzes and reports patterns and trends to management. Based on trends may provide training and insight to claims.
- Involved in the oversight and handling of extra contractual cases.
- Conducts annual audits as directed by senior management.
- Oversees Casualty process and guidelines.
- Other duties and responsibilities as assigned or required.
Education/Experience:
- JD, RN, BA/BS or equivalent combination of education and experience required.
- Continuing education through attainment of industry designations highly desirable.
- 5 years of an expert level of claims technical experience within a related specialized area
- Knowledge/Skills/Competencies:
- Moderate level of computer and line of business technical software skills required.
- Advanced organization and planning skills necessary
- Advanced oral and written communication skills required.
- Advanced interpersonal skills required.
- Valid driver’s license with minimum level of financial coverage/responsibility required by the Automobile Club. An acceptable motor vehicle record is required for the position.
- Represents the organization as the primary contact. Interacts with management and senior value-chain partners on matters requiring coordination across organizational lines. Achievement of objectives requires ability to influence others both internally and potentially externally.
The starting pay range for this position is:
$88,300.00 – $117,700.00
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.
.
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.