PIP No-Fault Claims Specialist II

AF - Group; United States; On-site; USD 56,700 - 94,900; Full time

Job summary

AF - Group in the United States seeks an intermediate Claims Representative II to manage a Michigan No-Fault PIP caseload of moderate to high complexity. You will investigate litigated and non-litigated claims, determine coverage, compensability, exposure, and resolution with independent judgment.

The role requires strong knowledge of Michigan No-Fault and MCA Plan, collaboration with insureds, providers, attorneys, and internal partners to ensure timely, accurate claim handling within state

Qualifications

• Bachelor’s degree or equivalent experience; MACP claim handling experience may be considered.
• Three years’ experience handling MCAP claims in an environment with the necessary skills and abilities; multi-jurisdiction experience preferred.
• Bilingual skills preferred.

Responsibilities

• Determines compensability under Michigan No Fault Act by thorough investigation.
• Assesses causal relationship to ensure appropriate payment of benefits.
• Establishes reserves based on claim profile and authority.
• Documents potential subrogation amounts and recovery opportunities.
• Manages medical bills and ensures payment aligns with treatment plans.
• Closes files post-resolution to meet performance standards and comply with law.
• Negotiates settlements within authority at earliest reasonable point.
• Collaborates with manager on complex files and with outside vendors for cost containment.
• Keeps abreast of Michigan No-Fault and MCA Plan statutes and case law.

Skills

Computers and company software

Medical terminology

Legal terminology

Michigan No Fault knowledge

Negotiation and conflict resolution

Education

Bachelor’s degree or equivalent experience

Tools

MACP claim handling software

Job description

AF - Group in the United States seeks an intermediate Claims Representative II to manage a Michigan No-Fault PIP caseload of moderate to high complexity. You will investigate litigated and non-litigated claims, determine coverage, compensability, exposure, and resolution with independent judgment.

The role requires strong knowledge of Michigan No-Fault and MCA Plan, collaboration with insureds, providers, attorneys, and internal partners to ensure timely, accurate claim handling within state