Sr Claim Specialist

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

5d•$76,700 - $119,434•Hybrid

About The Position

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.

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.
Five 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, No-Fault Reform, 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.
Manage claims involving the MCCA or quadriplegic, traumatic brain, amputations and other catastrophic injuries.
Deal 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.

Benefits

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 to support long-term financial goals.
3% automatic deferral upon eligibility; may contribute 1% to 50% of eligible earnings, either pre or post tax.
Company match of 50% paid on employee contributions up to 6% of pay, payable to employees following the end of the year; immediate vesting.
Additional company contribution of 4% of pay each pay day into your account; 100% vested after three (3) years of service.
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.
Full-time new employees will receive up to 12 PTO days annually; accrual based on start date and may include additional PTO based on role and/or state & local requirements.
Part-time employee PTO hours are calculated based upon the standard weekly hours the employee is scheduled to work and will accrue at a minimum of 3 hours per month.
10 company-paid holidays annually, in addition to 1 mental health day, 2 floating holidays, and 1 volunteer day.
8 company-paid holidays annually, in addition to 1 mental health day and 2 floating holidays.
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.