Sr. Claim Specialist (Michigan Assigned Claim Unit)

About the role

Join AAA – The Auto Club Group as a Senior Michigan PIP Claim Specialist, where you'll play a critical role in helping members navigate some of life's most challenging events. In this highly autonomous position, you'll leverage your investigative expertise, analytical thinking, and negotiation skills to manage complex Michigan Personal Injury Protection (PIP) claims from inception through resolution.

Responsibilities

• Claim handling responsibilities will include the following:
• reviewing assigned claims, contacting the insured and other affected parties, setting expectations for the remainder of the claim process, and initiating documentation in the claim handling system.
• Completing complex coverage analysis.
• Ensuring all possible policyholder benefits are identified.
• Creating additional sub-claims if needed.
• Completing an investigation of the facts regarding the claim to further and in more detail determine if the claim should be paid, the applicable limits or exclusions and possible recovery potential.
• Evaluating the financial value of the loss.
• Approving payments for the appropriate parties accordingly.
• Refer claims to other company units when necessary (e.g., Underwriting, Recovery Units or Claims Special Investigation Unit).
• Thoroughly documenting and/or coding the claim file and completing all claim closure and related activities in the assigned claims management system.
• Utilizing strong negotiating skills.
• Senior Claims Specialists assigned to the PIP unit are responsible for claims involving the MCCA or quadriplegic, traumatic brain, amputations and other catastrophic injuries. The role will require proficiency in dealing with the MCCA and attorney represented claims.
• Work with insureds, guardians, conservators, attorneys, treatment teams and case managers to obtain necessary information to complete the claims review process and make the appropriate determinations.

Qualifications

• Education (including Minimum Education And Any Licensing/certifications): Complete ACG Claim Representative Training Program or demonstrate equivalent knowledge or experience. In states where an Adjuster’s license is required, the candidate must be eligible to acquire a State Adjuster’s license within 90 days of hire and maintain as specified for appropriate states. A valid driver's license is required if the primary responsibilities of the role involve conducting in-person inspections or frequent in-person meetings with members.
• Experience: Five years of experience or equivalent training in the following: negotiation of claim settlements, securing and evaluating evidence, preparing manual and electronic estimates, subrogation claims, resolving coverage questions, taking statements, establishing clear evaluation and resolution plans for claims.
• Knowledge And Skills: Advance knowledge of: Essential Insurance Act (Michigan), Fair Trade Practices Act as it relates to claims, Subrogation procedures and processes, Intercompany arbitration, Handling simple litigation, Advance Knowledge Of Negligence Law, No-Fault Law, No-Fault Reform, medical terminology and human anatomy, MCCA and attorney represented claims.
• Skills: handle claims to the line, Claim Handling Standards, follow and apply ACG Claim policies, procedures and guidelines, work within assigned ACG Claim systems including basic PC software, perform basic claim file review and investigations, demonstrate effective communication skills (verbal and written), demonstrate customer service skills by building and maintaining relationships with insured/claimants while exhibiting understanding of their problems and responding to questions and concerns, analyze and solve problems while demonstrating sound decision-making skills, prioritize claim related functions, process time sensitive data and information from multiple sources, manage time, organize and plan workload and responsibilities, safely operate a motor vehicle in order to visit repair facilities, homes (for inspections), patients, etc., research, analyze and interpret subrogation laws in various states, travel outside of assigned territory which may involve overnight stay, relocate, work evenings or weekends.

Benefits

• 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 & Savings: 401(k) plan to support long-term financial goals, Tuition assistance (up to $5,250 annually; 80% covered by ACG), Professional certification support with 100% reimbursement for eligible programs, Opportunities for career development and advancement.

Pay

A Senior PIP Claim Specialist earns a competitive annual salary of $76,700-$102,000, along with the opportunity for an annual company bonus incentive.

Schedule

Monday-Friday 8am-5:30pm ET