Claim Specialist

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

3d•$67,300 - $104,000•Remote

About The Position

The Claim Specialist evaluates coverage, assesses claim exposures, and makes informed decisions to support fair and timely resolutions. Working with minimal supervision, the specialist works with members, medical providers, attorneys, and internal partners to manage challenging and complex claims while complying with applicable regulations and company standards. The 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 claims, claims involving the Michigan Catastrophic Claims Association (MCCA), and attorney-represented claims. The specialist investigates claims that may extend beyond standard PIP scenarios and reviews medical and claim information to make coverage and payment determinations. The role is currently remote from a home office for day-to-day work, except for occasional travel for meetings, collaborative activities, or team building as specified by leadership. This arrangement is subject to changes in ACG's Flex Work policy. The schedule is Monday through Friday, 8:30 a.m. to 5:30 p.m. Eastern Time; the posting also identifies evening or weekend work as a required skill/availability. The salary range 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 the Michigan 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.
Ability to handle claims according to Claim Handling Standards and follow and apply ACG Claim policies, procedures, and guidelines.
Ability to work within assigned ACG Claim systems, including basic PC software.
Ability to perform basic claim file reviews and investigations.
Effective verbal and written communication skills.
Customer-service skills, including building and maintaining relationships with insureds and claimants, understanding their problems, and responding to questions and concerns.
Problem-solving and sound decision-making skills.
Ability to prioritize claim-related functions and process time-sensitive data from multiple sources.
Time-management, organization, and workload-planning skills.
Ability to safely operate a motor vehicle to visit repair facilities, homes, patients, and other locations.
Ability to research, analyze, and interpret subrogation laws in various states.
Ability to travel outside the assigned territory, potentially overnight, and work evenings or weekends.
A valid driver's license is required if the 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 about 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.
Complete claim documentation, coding, and closure activities accurately and comply 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 extend beyond standard PIP claim scenarios.
Collaborate with insureds, physician offices, medical providers, and insurance carriers to obtain documentation and information.
Review medical and claim-related information to make accurate coverage and payment determinations.
Maintain compliance with state regulations, company policies, and claim-handling standards.
Travel outside the assigned territory, potentially including overnight stays, and work evenings or weekends as required.

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 with 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, including company matching and additional company contributions, subject to the stated eligibility and vesting terms.
Health Savings Account (HSA) and Flexible Spending Account (FSA) 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.
For full-time employees, 10 company-paid holidays, one mental health day, two floating holidays, and one volunteer day annually.
Paid leave programs, including parental, bereavement, jury duty, and military leave.
Tuition assistance of 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.