Sr. Claim Specialist

Job Type:

Full time

Exempt/Non Exempt:

Salary

Job Description:

Location Details:

Hybrid

Position Schedule / Shift:

Monday-Friday 8am-5:30pm ET

Position Summary:

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.

Key Responsibilities:

In this position, you will have the opportunity to:

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.

Senior Claims Specialists assigned to the PIP unit are responsible for claims involving the MCCA or quadriplegic, traumatic brain, amputations and other catastrophic injuries. The role will require proficiency in dealing 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.

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:

Five years of experience or equivalent training in the following:

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

No-Fault Reform

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

A Senior PIP Claim Specialist earns a competitive annual salary of $76,700-$119,433.60 along with the opportunity for an annual company bonus incentive.

Benefits

At ACG, we offer a comprehensive and flexible benefits package designed to support your health, financial well-being, and professional growth.

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.

Job Posting Period:

This position is expected to remain posted through Oc