First Party Medical/PIP Claims

CSAA Insurance Group

A contractor-position for a First Party Medical/PIP Claims Adjuster is open at CSAA Insurance Group!

CSAA Insurance Group, a AAA insurer, offers automobile, homeowners and other personal lines of insurance to AAA Members through AAA clubs in 23 states and the District of Columbia.

Founded in 1914, we have been rated "A" or better by A.M. Best for more than 90 years and are one of the top personal lines property casualty insurance groups in the United States, according to the National Association of Insurance Commissioners.

Benefit options available depending on contract factors and upon meeting requirements.

Job Summary
Handles to conclusion first-party Personal Injury Protection (PIP) claims, including Medical Pay, depending on level of proficiency. Cases are generally reserved up to $30,000. May handle catastrophic claims and transfer to high-level adjuster as necessary. Handles claims in multiple states.

Essential Functions / Principal Responsibilities

• Assigned as owning adjuster when injury exposure is identified for the first party, for files with reserves up to policy limits.
• Handles first-party medical payments and Personal Injury Protection claims.
• Negotiates, settles and resolves claims within authority level.
• Claims may involve additional suffixes such as income continuation and essential services as well as death and funeral benefits for fatality claims.
• Investigates to rule out exposures: uninsured/underinsured motorist, subrogation, dram shop.
• Makes coverage determinations and advises customers as to the proper course of action.
• Presents to committee on coverage issues, reserving and settlement authority.

Knowledge, Skills and Abilities Required:

• Negotiating skills and the ability to develop effective negotiating strategies
• Strong analytical, problem-solving and organizational skills
• Strong ability to work independently
• Strong decision-making ability
• Strong customer service orientation
• Basic math and computer skills
• Proficient oral and written communication skills and good command of the English language
• Ability to function in a team environment
• Ability to successfully complete training courses pertinent to job duties
• Understanding of statutory and regulatory requirements
• Understanding of AAA claims policies and procedures
• Ability to travel on rare occasions
• Ability to work extended hours and/or weekends
• Developing knowledge of litigation file handling for minor, moderate and complex litigated claims

Education, Work Experience, Licenses & Certifications Required:

• BA/BS in business, insurance or related area, or equivalent combination of education and experience
• 1-2 years of claims experience
• Ability to obtain license in required states
Preferred:

• 1-2 years of experience handling first-party medical benefits
• Bilingual a plus

Pursuant to the California Fair Chance Act, Los Angeles County Fair Chance Ordinance for Employers, Los Angeles Fair Chance Initiative for Hiring Ordinance, and San Francisco Fair Chance Ordinance, we will consider for employment qualified applicants with arrest and conviction records. Criminal history may have a direct, adverse, and negative relationship with some of the material job duties of this position. These include the duties and responsibilities listed above, as well as the abilities to adhere to company policies, exercise sound judgment, effectively manage stress and work safely and respectfully with others, exhibit trustworthiness, meet client expectations, standards, and accompanying requirements, and safeguard business operations and company reputation.

QUALIFICATION/LICENSURE
Work Authorization : Green Card, US Citizen
Preferred years of experience : 1 years
Travel required : No travel required
Shift timings :PDN-a0e6f59c-0dee-4aa3-995d-c98f734e9348

AZ