Offer summary

Qualifications:

Bachelor's degree or equivalent combination of education and experience required., 4-6 years of claims technical experience in a related specialized area is necessary., Advanced oral and written communication skills are essential., Moderate level of computer and line of business technical software skills required..

Key responsibilities:

Review and authorize claim reserves while providing settlement recommendations.

Ensure compliance with member service guidelines and regulatory standards.

Analyze and report patterns and trends to upper management, providing training as needed.

Conduct annual audits and facilitate investigative needs for complex claims.

Job description

Claims Examiner

Job Summary
This position is responsible for the review of high exposure claim files to ensure reserves are properly set and maintained, demands are handled appropriately and regulatory standards are adhered to for compliance. Subject matter expert in all disciplines. Provides guidance to ACE markets for the handling, strategy and conclusion of complex claims files. Supports the Claims business unit by providing a comprehensive level of technical support and assistance. Demonstrates discretion when assessing complex and unique claims.

Job Duties

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 upper management and may be involved in extra contractual cases. Based on trends may provide training and insight to claims and legal personnel.
Conducts annual audits as directed by senior management.
Must exercise discretion independent of supervision when assessing complex and unique claims. Facilitate and recommend investigative needs, value and distinguish between allegations and facts.
Adapt to changing laws and Department of Insurance regulations.

Qualifications

Bachelors Equivalent combination of education and experience
4-6 years Claims technical experience within a related specialized area Required
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, acceptable Department of Motor Vehicles record and minimum liability insurance - Issued by State Required

The starting pay range for this position is:

$78,200.00 - $104,100.00

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 (FCIHO), the Unincorporated Los Angeles County (ULAC) regulation, and the California Fair Chance Act (CFCA).

Required profile