PIP Claim Specialist - Michigan

AAA-The Auto Club Group•MI-Admin Office Building (AOB), MI

4d•$65,700 - $87,600•Hybrid

About The Position

Join AAA – The Auto Club Group as a 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. Claim Specialists are assigned to the PIP unit and are responsible for Michigan PIP intermediate claims involving fractures, mild closed head injuries, surgical procedures, and claims involving attendant care. The role may require proficiency in dealing with the MCCA and attorney represented claims. May handle losses beyond those identified previously. Work with insureds, physicians’ offices and medical insurance carriers to obtain necessary information to complete the claims review process and make the appropriate determinations.

Requirements

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.
Three years of experience or equivalent training in negotiation of claim settlements, securing and evaluating evidence, preparing manual and electronic estimates, subrogation claims, resolving coverage questions, taking statements, and establishing clear evaluation and resolution plans for claims.
Advance knowledge of Essential Insurance Act (Michigan), Fair Trade Practices Act as it relates to claims, Subrogation procedures and processes, Intercompany arbitration, and Handling simple litigation.
Advance knowledge of Negligence Law, No-Fault Law, medical terminology and human anatomy, and MCCA and attorney represented claims.
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.

Nice To Haves

Associate degree in Business Administration, Insurance or a related field or the equivalent in 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, contact the insured and other affected parties, set expectations for the remainder of the claim process, and initiate documentation in the claim handling system.
Complete complex coverage analysis.
Ensure all possible policyholder benefits are identified.
Create additional sub-claims if needed.
Complete 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.
Conduct thorough reviews of damages and determine the applicability of state law and other factors related to the claim.
Evaluate the financial value of the loss.
Approve 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 document and/or code the claim file and complete all claim closure and related activities in the assigned claims management system.
Utilize strong negotiating skills.

Benefits

PTO, paid sick leave
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
Health Savings Account (HSA) and Flexible Spending Accounts (FSA) options.
Paid Time Off (PTO): Accrual-based, increases with tenure, eligible at 90 days of employment.
10 company-paid holidays annually, in addition to 1 mental health day, 2 floating holidays, and 1 volunteer day.
Paid leave programs, including parental, bereavement, jury duty, and military leave.
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.
Complimentary AAA membership with roadside assistance and travel discounts.
Adoption assistance program.