Claim Specialist Michigan PIP

AAA-The Auto Club Group•MI-HMMI Empl Work From Home, MI

2d•$67,300 - $104,000•Remote

About The Position

The Claim Specialist evaluates coverage, assesses claim exposures, and makes informed decisions to achieve fair and timely resolutions. Working with members, medical providers, attorneys, and internal partners under minimal supervision, the specialist manages challenging and complex claims while complying with applicable regulations and company standards. This role requires experience interpreting and applying Michigan No-Fault reform regulations to support accurate claim handling and benefit determinations. The position handles intermediate to complex Michigan Personal Injury Protection (PIP) claims, including fractures, mild closed head injuries, surgical procedures, attendant care, Michigan Catastrophic Claims Association (MCCA) matters, and attorney-represented claims. It also investigates losses that may extend beyond standard PIP scenarios and works with insureds, physician offices, medical providers, and insurance carriers to obtain information and make coverage and payment determinations. The role is remote for day-to-day operations from a home office, subject to the company’s Flex Work policy. Occasional travel may be required for meetings, collaboration, team building, inspections, or other activities. The stated schedule is Monday through Friday, 8:30 a.m. to 5:30 p.m. ET. The position is full-time and salaried. Compensation is $67,300–$104,000 annually, with an opportunity for an annual company bonus incentive.

Requirements

Complete the ACG Claim Representative Training Program or demonstrate equivalent knowledge or experience.
Where an adjuster’s license is required, be eligible to acquire a State Adjuster’s license within 90 days of hire and maintain it as required in applicable states.
Three years of experience or equivalent training in negotiating claim settlements, securing and evaluating evidence, preparing manual and electronic estimates, handling subrogation claims, resolving coverage questions, taking statements, and establishing claim evaluation and resolution plans.
Advanced knowledge of Michigan’s Essential Insurance Act, the Fair Trade Practices Act as it relates to claims, subrogation procedures and processes, intercompany arbitration, simple litigation, negligence law, No-Fault Law, medical terminology and human anatomy, MCCA, and attorney-represented claims.
Handle claims according to Claim Handling Standards and apply ACG Claim policies, procedures, and guidelines.
Use assigned ACG Claim systems and basic PC software.
Perform basic claim file reviews and investigations.
Demonstrate effective verbal and written communication skills.
Build and maintain relationships with insureds and claimants, understand their problems, and respond to questions and concerns.
Analyze and solve problems using sound judgment and decision-making skills.
Prioritize claim-related functions and process time-sensitive information from multiple sources.
Manage time and organize and plan workload and responsibilities.
Research, analyze, and interpret subrogation laws in various states.
A valid driver’s license is required if the role’s primary responsibilities involve in-person inspections or frequent in-person meetings with members.

Nice To Haves

Bachelor’s degree or equivalent in Business Administration, Human Resources Management, or a related field.
Associate degree in Business Administration, Insurance, or a related field, or equivalent related work experience.
Completion of the Insurance Institute of America’s General Insurance Program, Associate in Claims, Associate in Management, or equivalent.
CPCU coursework or designation.

Responsibilities

Review assigned claims and initiate claim-handling activities.
Contact insureds and other affected parties to gather information and set expectations for the claims process.
Document claim activity and maintain accurate records in the claims management system.
Perform complex coverage analysis and identify applicable policyholder benefits.
Establish and manage sub-claims as needed.
Investigate coverage applicability, claim validity, policy limits, exclusions, and recovery opportunities.
Analyze claim facts, damages, state laws, and other factors affecting claim decisions.
Evaluate the financial value of losses and authorize appropriate claim payments.
Negotiate settlements and claim resolutions.
Refer claims to specialized departments, including Underwriting, Recovery Units, and the Claims Special Investigation Unit (SIU), when necessary.
Ensure complete and accurate claim documentation, coding, closure activities, and compliance with company procedures.
Handle intermediate to complex Michigan PIP claims, including fractures, mild closed head injuries, surgical procedures, and attendant care claims.
Manage claims involving the Michigan Catastrophic Claims Association (MCCA).
Handle attorney-represented claims and navigate legal involvement throughout the claim process.
Investigate and manage losses that may extend beyond standard PIP claim scenarios.
Collaborate with insureds, physician offices, medical providers, and insurance carriers to obtain necessary documentation and information.
Review medical and claim-related information to make coverage and payment determinations.
Maintain compliance with applicable state regulations, company policies, and claim-handling standards.
Safely operate a motor vehicle when needed to visit repair facilities, homes, patients, or other locations.
Travel outside the assigned territory, which may involve overnight stays, and work evenings or weekends as needed.

Benefits

Competitive annual salary of $67,300–$104,000 and opportunity for an annual company bonus incentive.
Medical plans with multiple coverage options, including HSA eligibility, and prescription drug coverage.
Dental and vision benefits.
Employee Assistance Program.
Company-paid basic life insurance and optional supplemental life insurance and dependent coverage.
Short-term and long-term disability coverage.
Critical illness, accident, and pet insurance options.
401(k) plan with automatic deferral, company matching contributions, and an additional company contribution.
Health Savings Account and Flexible Spending Account options.
Accrual-based paid time off, with full-time new employees receiving up to 12 PTO days annually; eligibility begins after 90 days of employment.
Ten company-paid holidays annually for eligible full-time employees, plus one mental health day, two floating holidays, and one volunteer day.
Paid leave programs, including parental, bereavement, jury duty, and military leave.
Tuition assistance up to $5,250 annually, with 80% covered by ACG.
100% reimbursement for eligible professional certification programs.
Career development and advancement opportunities.
Complimentary AAA membership with roadside assistance and travel discounts.
Adoption assistance program.