Sr Claim Specialist

AAA-The Auto Club Group•MI-HMI1 Empl Work From Home, MI

6d•$76,700 - $119,434•Hybrid

About The Position

Join AAA – The Auto Club Group as a Senior Michigan PIP Claim Specialist, managing complex Michigan Personal Injury Protection (PIP) claims from inception through resolution. This highly autonomous position uses investigative expertise, analytical thinking, and negotiation skills to help members navigate challenging events. Senior PIP specialists handle claims involving the MCCA and catastrophic injuries, including quadriplegia, traumatic brain injuries, and amputations. The role involves working with insureds, guardians, conservators, attorneys, treatment teams, and case managers to gather information, review claims, and make appropriate determinations. The position is hybrid and scheduled Monday through Friday, 8:00 a.m.–5:30 p.m. ET. Day-to-day work may be performed remotely from a home office, with occasional travel for meetings, collaboration, or team-building as specified by leadership; this arrangement may change under ACG’s Flex Work policy. The role may also require travel outside the assigned territory, potentially including overnight stays, and the listed qualifications include the ability to relocate or work evenings or weekends. The annual salary range is $76,700–$119,433.60, with an opportunity for an annual company bonus incentive. ACG offers benefits that include health and insurance coverage, retirement savings, paid time off and holidays, paid leave programs, tuition and certification support, AAA membership, and adoption assistance.

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 for the applicable state.
Five years of experience or equivalent training in negotiating claim settlements, securing and evaluating evidence, preparing manual and electronic estimates, subrogation claims, resolving coverage questions, taking statements, and establishing claim evaluation and resolution plans.
Advanced knowledge of the Michigan Essential Insurance Act, Fair Trade Practices Act as it relates to claims, subrogation procedures and processes, intercompany arbitration, and handling simple litigation.
Advanced knowledge of negligence law, No-Fault Law and No-Fault Reform, medical terminology and human anatomy, and MCCA and attorney-represented claims.
Handle claims to Claim Handling Standards and follow and apply ACG Claim policies, procedures, and guidelines.
Work within assigned ACG Claim systems, including basic PC software; perform basic claim file reviews and investigations.
Demonstrate effective verbal and written communication and customer service skills, building and maintaining relationships with insureds and claimants while responding to their concerns.
Analyze and solve problems, make sound decisions, prioritize claim-related functions, and process time-sensitive information from multiple sources.
Manage time and organize and plan workload and responsibilities.
Safely operate a motor vehicle to visit repair facilities, homes, patients, or other locations.
Research, analyze, and interpret subrogation laws in various states.
Travel outside the assigned territory, which may involve overnight stays.
Relocate or work evenings or weekends, as stated among the listed skills.
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

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, contact insureds and other affected parties, set expectations for the claim process, and initiate claim documentation.
Complete complex coverage analysis and identify all possible policyholder benefits.
Create additional sub-claims when needed.
Investigate claim facts to determine whether payment is appropriate, applicable limits or exclusions, and potential recovery opportunities.
Review damages and determine the applicability of state law and other relevant factors.
Evaluate the financial value of losses and approve appropriate payments.
Refer claims to other company units when necessary, including Underwriting, Recovery Units, or the Claims Special Investigation Unit.
Document and/or code claim files thoroughly and complete claim closure and related activities in the claims management system.
Use strong negotiation skills to resolve claims.
Work with insureds, guardians, conservators, attorneys, treatment teams, and case managers to obtain information needed to review and determine claims.

Benefits

Annual company bonus incentive.
Medical plans with multiple coverage options, including HSA eligibility.
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 a 50% company match on employee contributions up to 6% of pay, subject to the stated terms.
Additional company contribution of 4% of pay each pay day, subject to vesting terms.
Health Savings Account and Flexible Spending Account options.
Accrual-based paid time off, subject to eligibility and applicable terms.
Company-paid holidays, plus mental health, floating, and volunteer days for eligible full-time employees.
Paid parental, bereavement, jury duty, and military leave programs.
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.