A

Auto Club Group

AAA member association for roadside, insurance and travel

Senior Claim Specialist - PIP Litigation Michigan

Claims AdjudicationUpdated on Nov 10
Full-timeMichigan, USA$76.7k - $119.4k /yr

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 applicable 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, subrogation claims, resolving coverage questions, taking statements, and establishing clear evaluation and resolution plans for claims.
  • Have advanced knowledge of the Essential Insurance Act (Michigan), Fair Trade Practices Act as it relates to claims, subrogation procedures and processes, intercompany arbitration, and handling simple litigation.
  • Have advanced knowledge of negligence law, no-fault law, no-fault reform, medical terminology, human anatomy, MCCA, and attorney-represented claims.
  • Handle claims to the line Claim Handling Standards and follow and apply ACG Claim policies, procedures, and guidelines.
  • Work within assigned ACG Claim systems, including basic PC software.
  • Perform basic claim file reviews and investigations.
  • Demonstrate effective verbal and written communication skills.
  • Build and maintain relationships with insureds and claimants, understand their problems, and respond to questions and concerns.
  • Analyze and solve problems while demonstrating sound decision-making skills.
  • Prioritize claim-related functions and process time-sensitive data and information from multiple sources.
  • Manage time, organize, and plan workload and responsibilities.
  • Safely operate a motor vehicle to visit repair facilities, homes for inspections, patients, and other locations.
  • Research, analyze, and interpret subrogation laws in various states.
  • Travel outside the assigned territory, which may involve overnight stays.
  • Be able to relocate and work evenings or weekends.

Responsibilities

  • Independently manage complex and litigated Michigan PIP claims, using expertise in Michigan No-Fault/PIP claims, complex investigations, litigation management, and negotiation to evaluate exposures, develop claim strategies, resolve disputed matters, negotiate resolutions, and move files toward timely outcomes.
  • Review assigned claims, contact insureds and other affected parties, set expectations for the remainder of the claim process, and initiate documentation in the claim handling system.
  • Complete complex coverage analyses and ensure all possible policyholder benefits are identified.
  • Create additional sub-claims when needed.
  • Investigate claim facts to determine whether claims should be paid, applicable limits or exclusions, and possible recovery potential.
  • Review damages and determine the applicability of state law and other factors related to claims.
  • Evaluate the financial value of losses and approve payments for appropriate parties.
  • Refer claims to other company units when necessary, including Underwriting, Recovery Units, and the Claims Special Investigation Unit.
  • Document and code claim files and complete claim closure and related activities in the assigned claims management system.
  • Use negotiation skills to resolve claims.
  • Handle PIP-unit claims involving the MCCA, quadriplegia, traumatic brain injuries, amputations, and other catastrophic injuries.
  • Work with insureds, guardians, conservators, attorneys, treatment teams, and case managers to obtain information needed to review claims and make appropriate determinations.
  • Represent AAA – The Auto Club Group in court proceedings and support court appearances and litigation matters throughout Michigan as needed.

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

Recently Posted Jobs

Explore more opportunities at Auto Club Group

See more jobs