Casualty Claim Specialist – Michigan PIP

AAA-The Auto Club Group; Michigan; Hybrid; USD 65,000 - 75,000; Full time

Job summary

A leading insurance organization in Michigan is seeking a Casualty Claim Specialist to manage complex claims, ensuring compliance with state laws and maximizing policyholder benefits. The role involves effective communication with insureds, medical carriers, and legal entities, providing a competitive salary of $65,700 to $75,000 plus benefits. A valid driver's license and three years of relevant experience are required.

Benefits

401k Match

Medical

Dental

Vision

PTO

Paid Holidays

Tuition Reimbursement

Qualifications

• Three years of experience in claim settlements and evidence evaluation.
• Eligible for State Adjuster's license within 90 days of hire.
• Valid driver's license required if performing in-person inspections.

Responsibilities

• Review assigned claims and contact affected parties.
• Conduct coverage analysis and determine benefits.
• Document and code claims in the management system.

Skills

Negotiation skills

Legal knowledge (Negligence Law, No-Fault Law)

Customer service skills

Analytical skills

Education

High school diploma

Associate degree in Business Administration or related field

Job description

Overview

Join to apply for the Casualty Claim Specialist – Michigan PIP role at AAA-The Auto Club Group.

The Auto Club Group (ACG) provides membership, travel, insurance, and financial services. AAA continues to invest in technology and innovative products, and is committed to creating an inclusive environment of diverse backgrounds and viewpoints.

What you will do

The Auto Club Group is seeking a prospective Claim Specialist who will work under minimal supervision with a high-level approval authority to handle complex technical issues and complex claims. In this position, you will have the opportunity to:

• 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.
• Identify all possible policyholder benefits.
• Create additional sub-claims if needed.
• Investigate the facts regarding the claim to 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 and approve payments accordingly.
• Refer claims to other company units when necessary (e.g., Underwriting, Recovery Units or Claims Special Investigation Unit).
• Document and code the claim file and complete all claim closure and related activities in the assigned claims management system.
• Utilize strong negotiating skills.

Claim Specialists are assigned to the PIP unit and handle Michigan PIP intermediate claims including fractures, mild closed head injuries, surgical procedures, and 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 information to complete the claims review process and make determinations.

Work Environment
This position is currently able to work remotely from a home office location for day-to-day operations unless occasional travel is required for meetings, collaborative activities, or team building. This is subject to change based on amendments to the ACG Flex Work policy.

Benefits

Claim Specialist will earn a competitive salary of $65,700 to $75,000 annually with annual bonus potential based on performance. Benefits include:

• 401k Match
• Medical
• Dental
• Vision
• PTO
• Paid Holidays
• Tuition Reimbursement

Qualifications

Required Qualifications (these Are The Minimum Requirements To Qualify)

Education

• Complete ACG Claim Representative Training Program or demonstrate equivalent knowledge or experience
• In states where an Adjuster’s license is required, 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 involve conducting in-person inspections or frequent in-person meetings with members.

Experience

• 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; establishing clear evaluation and resolution plans for claims.

Knowledge and Skills

• Advance knowledge of: Essential Insurance Act (Michigan); Fair Trade Practices Act as it relates to claims; subrogation procedures; intercompany arbitration; handling simple litigation.
• Advance knowledge of: Negligence Law; No-Fault Law; medical terminology and human anatomy; MCCA and attorney-represented claims.
• Ability to: handle claims to the line Claim Handling Standards; follow and apply ACG Claim policies, procedures and guidelines; work within assigned ACG Claim systems; perform basic claim file review and investigations; demonstrate effective communication and customer service skills; analyze and solve problems; prioritize claim-related functions; manage time and plan workload; research, analyze, and interpret subrogation laws in various states.

Preferred Qualifications

Education

• Associate degree in Business Administration, Insurance or related field or equivalent experience
• Completion of Insurance Institute of America programs (General Insurance, Associate in Claims, Associate in Management) or equivalent
• CPCU coursework or designation

Who We Are

We are part of AAA The Auto Club Group (ACG), serving approximately 14+ million members and customers across 14 states and 2 U.S. territories. ACG is a member of the national AAA federation and the second largest AAA club in North America. AAA focuses on quality service for insurance, travel, financial services, and roadside assistance, and values an inclusive, diverse workplace. AAA is an equal opportunity/affirmative action employer. All qualified applicants will receive consideration without regard to race, color, religion, sex, gender identity, sexual orientation, national origin, disability or protected veteran status.

Regular and reliable attendance is essential for this role. A background and drug screen may be required as part of the employment process.

For more information about AAA The Auto Club Group, visit www.aaa.com