PIP Claim Specialist

Job Type

Full time

Hybrid

Monday-Friday 8:30am-5:30pm ET

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.

• 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

• 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.

• Three 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

• 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.

• 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

• 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

This position is currently able to work remotely from a home office location for day-to-day operations unless occasional travel for meetin