Michigan PIP Claim Specialist

ACS Auto Club Services, Inc.; Michigan; Hybrid; USD 67,000 - 105,000; Full time

Benefits offered by this job

Health & Wellness Medical plans with H

Dental and vision benefits

401(k) plan with company match

Paid time off (PTO)

Job summary

The Auto Club Group in Michigan is seeking a Michigan PIP Claim Specialist who will navigate complex personal injury protection claims with autonomy, investigative rigor, and strong negotiation skills.

This hybrid role allows remote work from a home office with occasional travel, offering a competitive salary range of $67,317.20 to $104,811.20 plus a potential annual bonus and extensive benefits, within AAA's nationwide platform.

Qualifications

• Complete ACG Claim Representative Training Program or demonstrate equivalent knowledge or experience.
• Eligible to acquire a State Adjuster’s license within 90 days of hire in states requiring it.
• Valid driver’s license required if in-person work is part of the role.

Responsibilities

• Reviewing assigned claims, contact insured and parties, set expectations, document in claims system.
• Complete complex coverage analysis and identify all potential policyholder benefits.
• Investigate facts to determine payment eligibility, limits, exclusions and recovery potential.
• Approve payments and refer claims to relevant units when needed.
• Document and code the claim file and close claims in the system.

Skills

Negotiation

Investigation

Analytical thinking

Communication

Decision making

Time management

Customer service

Education

Associate degree in Business Admin/Insurance

CPCU or Insurance coursework

Tools

ACG Claim systems

PC software

Job description

Job Type: Full time Exempt/Non Exempt: Salary

Job Description: Location Details: Hybrid Position Schedule / Shift: Monday-Friday 8:30am-5:30pm ET

Position Summary:

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.

Key Responsibilities:

• Claim handling responsibilities will include the following:
• Reviewing assigned claims, contacting the insured and other affected parties, setting expectations for the remainder of the claim process, and initiating 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.
• 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.

Qualifications:

• Required Education (including minimum education and any licensing/certifications): 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.
• Experience: Three years of experience or equivalent training in the following:

Experience (detailed responsibilities):

• 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 and processes Intercompany arbitration Handling simple litigation.
• Advance knowledge of: Negligence Law No-Fault Law medical terminology and human anatomy MCCA and attorney represented claims.
• Skills: 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.

Preferred Education:

• 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.

Work Environment:

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

Compensation & Benefits Overview:

ACG complies with all applicable state and local laws regarding required benefits (including PTO, paid sick leave, etc.).

Compensation: MI PIP Claim Specialist earns a competitive annual salary of $67,317.20-$104,811.20 along with the opportunity for an annual company bonus incentive.

Benefits:

• Health & Wellness Medical plans with multiple coverage options, including HSA eligibility.
• Prescription drug coverage.
• Dental and vision benefits.
• Employee Assistance Program (confidential support services).
• Financial Protection & Insurance 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.
• Retirement & Savings 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.
• Time Off & Leave 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.
• Paid holidays: Full-time employees are eligible for 10 company-paid holidays annually, in addition to 1 mental health day, 2 floating holidays, and 1 volunteer day. Holidays will vary by business schedules Part-time employees are eligible for 8 company-paid holidays annually, in addition to 1 mental health day and 2 floating holidays. Holidays will vary by business unit schedules.
• Paid leave programs, including parental, bereavement, jury duty, and military leave.
• Career Growth & Education 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.
• Additional Perks Complimentary AAA membership with roadside assistance and travel discounts.
• Adoption assistance program.

Who We Are:

Become a part of something bigger. The Auto Club Group (ACG) provides membership, travel, insurance, and financial service offerings to approximately 14+ million members and customers across 14 states and 2 U.S. territories through AAA, Meemic, and Fremont brands. ACG belongs to the national AAA federation and is the second largest AAA club in North America. By continuing to invest in more advanced technology, pursuing innovative products, and hiring a highly skilled workforce, AAA continues to build upon its heritage of providing quality service and helping our members enjoy life’s journey through insurance, travel, financial services, and roadside assistance. And when you join our team, one of the first things you’ll notice is that same, whole-hearted, enthusiastic advocacy for each other. We have positions available for every walk of life! AAA prides itself on creating an inclusive and welcoming environment of diverse backgrounds, experiences, and viewpoints, realizing our differences make us stronger.

Additional Information:

Important Note: ACG’s Compensation philosophy is to provide a market-competitive structure of fair, equitable and performance-based pay to attract and retain excellent talent that will enable ACG to meet its short and long-term goals. ACG utilizes a geographic pay differential as part of the base salary compensation program. Pay ranges outlined in this posting are based on the various ranges within the geographic areas which ACG operates. Salary at time of offer is determined based on these and other factors as associated with the job and job level. The above statements describe the principal and essential functions, but not all functions that may be inherent in the job. This job requires the ability to perform duties contained in the job description for this position, including, but not limited to, the above requirements. Reasonable accommodations will be made for otherwise qualified applicants, as needed, to enable them to fulfill these requirements.

Equal Opportunity Statement:

The Auto Club Group, and all its affiliated companies, is an equal opportunity employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, gender identity, sexual orientation, national origin, disability or protected veteran status.

Safety:

Regular and reliable attendance is essential for the function of this job. AAA The Auto Club Group is committed to providing a safe workplace. Every applicant offered employment within The Auto Club Group will be required to consent to a background and drug screen based on the requirements of the position.

Disability Accommodation:

The Auto Club Group (ACG) provides membership, travel, insurance and financial services offerings to approximately 13+ million members and customers across 14 states and 2 U.S. territories through the AAA, Meemic and Fremont brands. ACG belongs to the national AAA federation and is the second largest AAA club in North America. If you have a disability and require an accommodation to help you complete our employment application process, please send an email to [e-mail] indicating the accommodation / assistance needed and a member of the Talent Acquisition Team will follow up to assist you within 2 business days.