Claim Customer Service Representative

Posted 7 days ago

auto club groupCharlotte (NC)

Insurance Claims and Policy Processing Clerks All Other Insurance Related Activities

SENIORITY

Junior

SALARY

$19.00 - $22.00

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About the role

Claim Customer Service Representative As a Claim Customer Service Representative, you will serve as the first point of contact for members reporting losses, guiding them through the claims process with professionalism, empathy, and efficiency. In this fast-paced call center environment, you will handle claim inquiries, initiate claim services, and resolve low-complexity, one-touch claims by interpreting coverage, authorizing services, processing payments, and ensuring compliance with company policies and state regulations. This role combines strong customer service, critical thinking, and claims handling expertise to deliver seamless support and timely claim resolution while promoting a positive member experience.

Key Responsibilities:

Responsible for taking first notice of loss
Handling claims inquiries
Identifies non-complex claims for one-touch claim adjudication upon intake
Determines the type and extent of loss and ensures the claim is consistent with all reported facts
Reviews necessary legal and police/fire reports to process claims as necessary
Interprets policy language and applies coverage to authorize or deny claims
Initiates services, authorizes, and resolves issues related to services such as car rental and vehicle repairs and non-complex homeowner claims (e.g. food spoilage)
Initiates and creates payments
Settles or recommends settlement value of claims within specified limits
Identifies additional claim exposures and creates sub-claims as necessary
Refers files for investigation as warranted
Informs insured of coverage decision on claims within defined scope
Responds to claimant inquiries and explains payments
Documents claim files
Reviews the status of open and closed reserves and makes adjustments consistent with exposures
Identifies claims for salvage and subrogation potential in accordance with company policy
Closes claims in a timely manner
Ensures compliance with state regulations
Completes first notice of loss (FNOL) for all policy products and handles inbound claim inquiries received via phone, the ACG website and other sources
Provides basic information to members regarding claims procedures in accordance with Customer Interaction Model
Promotes customer satisfaction and provides seamless service to ensure customer service goals and standards are met
Navigates through various sources of information and claim processing systems (E.g., FACTS, CPS, Point of Sale, IPM insurance systems, Intranet/Internet, manuals and call center models)

Qualifications: Required

Education: Completion of AAA approved call center training program, appropriate level ACG Claim Representative Training program and ongoing training and certification for the position Must be eligible to acquire and maintain a state adjuster's license for appropriate state(s).

Experience:

Processing FNOL information and handling claim inquiries utilizing PCs and software packages (e.g. ACG claim systems, Microsoft Word, Excel)
Reading and comprehending various Customer Care service tools (manuals, work models, etc.)Performing mathematical calculations including adding, subtracting, percentages, etc.
Analyzing and resolving problems

Knowledge and Skills: Knowledge of:

Claim processing policy and procedures
General claim processing functions
Claim processing systems
Telephone etiquette
Ability to:
Provide a high level of customer service in a professional call center environment using the following skills:
Strong interpersonal skills demonstrated through work experience, participation in extra-curricular activities and/or community involvement
Strong communication skills required in understanding customers' concerns and to provide high-quality customer service as demonstrated through the effective use of the customer care call center model
Excellent verbal communication skills service
Strong written communications skills (example may be required at time of interview) needed to respond in a professional manner to members/customers inquiries
Effective listening skills
Ability to learn and apply claim handling skills, including:
Policy analysis and coverage application
Claim payment coding, issuance, and exception handling
Proactive customer contact and issue resolution
Car rental coverage knowledge
Claims related policies and procedures
Auto and home repair estimate basics and compliance review
State compliance requirements
Subrogation identification and referral (e.g. MI liability basics regarding uninsured motorists)
Understand insurance fraud scenarios and recognize potential fraud indicators
Issue written correspondence
Prioritize claims-related functions
Successfully complete at least one of the following within 9 months of hire:
AAA general claim policy training
Policy, negligence and no-fault training
Proactively contact and effectively interact with the public and business partners through outbound communication
Work independently
Communicate effectively over the telephone
Work under pressure
Record and maintain information accurately and in a timely fashion
Work effectively in a team environment
Sit for the majority of the workday

Willingness and ability to work irregular shifts, including weekends and holidays. Preferred

Education: Associate's degree in business administration or a related field, or the equivalent in related work experience. Completion of (IIA) Insurance Institute of America or other insurance coursework.

Experience:

North or South Carolina Adjuster's license preferred, but not required
Working within a claim related field such as insurance, automotive, medical or legal services
Working withing a call center
Investigating and resolving claims related problems
Handling claims or claim support tasks
Bilingual – Spanish, a plus
Customer service background
Excellent communication both oral and written
Knowledge of:
Auto and home repair basics and cost estimating
State insurance laws, specifically North and South Carolina
Property and casualty insurance policy language and provisions
Liability, negligence, No-Fault principles and subrogation insurance claims

Work Environment: This position is currently available on a hybrid basis only. Employees will work remotely from a home office location for most day-to-day operations with in- office reporting and travel for duties, meetings, collaborative activities, or team building activities specified by leadership. This reporting status is subject to change based on amendments and/or modifications to the ACG Flex Work policy. Compensation & Benefits Overview: ACG complies with all applicable state and local laws regarding required benefits (including PTO, paid sick leave, etc.).CompensationA Claims Customer Service Representative earns a competitive hourly salary of $19.00 - $22.00 along with the opportunity for an annual company bonus incentive.

Benefits: Medical plans with multiple coverage options, including HSA eligibility. Prescription drug coverage. Dental and vision benefits. Employee Assistance Program (confidential support services).Company-paid basic life insurance. Optional supplemental life insurance and dependent coverage. Short-term and long-term disability coverage. Critical illness, accident, and pet insurance options.401(k) plan to support long-term financial goals. 3% automatic deferral upon eligibility; may contribute 1

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