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Auto Club Group

AAA member association for roadside, insurance and travel

Senior Michigan PIP Claim Specialist

Claims AdjudicationUpdated on Nov 10
Full-timeMichigan, USA

About the Job

Requirements

  • Complete the ACG Claim Representative Training Program or demonstrate equivalent knowledge or experience.
  • In states where an adjuster's license is required, be eligible to acquire a State Adjuster's license within 90 days of hire and maintain it as specified for the appropriate states.
  • Have a valid driver's license if the primary responsibilities involve conducting in-person inspections or frequent in-person meetings with members.
  • Have five years of experience or equivalent training in negotiating claim settlements, securing and evaluating evidence, preparing manual and electronic estimates, handling subrogation claims, resolving coverage questions, taking statements, and establishing clear evaluation and resolution plans for claims.
  • Have advanced knowledge of the Michigan Essential Insurance Act and Fair Trade Practices Act as they relate to claims, subrogation procedures and processes, intercompany arbitration, and handling simple litigation.
  • Have advanced knowledge of negligence law, no-fault law and reform, medical terminology and human anatomy, and MCCA and attorney-represented claims.
  • Be able to handle claims in line with Claim Handling Standards and apply ACG Claim policies, procedures, and guidelines.
  • Be able to work within assigned ACG Claim systems, including basic PC software, and perform basic claim file reviews and investigations.
  • Demonstrate effective verbal and written communication skills and customer service skills by building and maintaining relationships with insureds and claimants, understanding their problems, and responding to questions and concerns.
  • Be able to analyze and solve problems, make sound decisions, prioritize claim-related functions, process time-sensitive data and information from multiple sources, and manage, organize, and plan workload and responsibilities.
  • Be able to safely operate a motor vehicle for visits to repair facilities, homes for inspections, patients, and other locations.
  • Be able to research, analyze, and interpret subrogation laws in various states.
  • Be able to travel outside the assigned territory, which may involve overnight stays, and relocate or work evenings or weekends.

Responsibilities

  • Review assigned claims, contact insureds and other affected parties, set expectations for the claim process, and initiate documentation in the claim handling system.
  • Complete complex coverage analysis and identify all possible policyholder benefits.
  • Create additional subclaims when needed.
  • Investigate claim facts to determine whether a claim should be paid, applicable limits or exclusions, and possible recovery potential.
  • Review damages thoroughly and determine the applicability of state law and other factors related to the claim.
  • Evaluate the financial value of losses and approve payments for the appropriate parties.
  • Refer claims to other company units when necessary, including Underwriting, Recovery Units, or the Claims Special Investigation Unit.
  • Document and/or code claim files thoroughly and complete claim closure and related activities in the assigned claims management system.
  • Use negotiation skills to resolve claims.
  • Handle PIP claims involving the MCCA, quadriplegic injuries, traumatic brain injuries, amputations, and other catastrophic injuries; work with insureds, guardians, conservators, attorneys, treatment teams, and case managers to obtain information for claim reviews and determinations.

Desired Qualifications

  • An associate degree in Business Administration, Insurance, or a related field, or equivalent 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.

About the Company

Auto Club Group

AAA member association for roadside, insurance and travel

Auto Club Group is a nonprofit AAA member association providing roadside assistance, insurance and travel services through regional clubs and related businesses. Members pay annual dues for help with vehicle breakdowns and access to discounts, while the group's insurance companies and agencies sell coverage for cars, homes and other needs. Its travel services help members arrange holidays, cruises and tours, and its financial offerings include banking products provided through partners. The organization also promotes traffic safety and advocates for motorists within the wider AAA federation. With operating roots dating to 1901, Auto Club Group is headquartered in Dearborn, Michigan.

Company size
5,001-10,000
Company stage
Not listed
Total funding
Not listed
Headquarters
Dearborn, MI
Founded
1901

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