Claim Customer Service Representative

Job Type:

Full time

Exempt/Non Exempt:

Hourly

Job Description:

Location Details:

Hybrid – Charlotte, North Carolina

Eligible candidates must reside within a fifty-mile radius of Charlotte, North Carolina for consideration.

Position Schedule / Shift:

Monday – Friday: 8:30 AM EST – 5:30 PM EST

Employees in this position will report in office 1 – 2 times per month, as assigned by management.

Position Summary:

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.).

Compensation

A 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

At ACG, we offer a comprehensive and flexible benefits package designed to support your health, financial well-being, and professional growth.

Health & Wellness

• •Medical plans with multiple coverage options, including HSA eligibility.
• •Prescription drug coverage.
• •Dental and vision benefits.
• •Employee Assistance Program (confidential support services).

Financial Protection & Insurance

• •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.

Retirement &