PIP Claim Specialist

Job Type:Full time Exempt/Non Exempt:

Salary

Job Description:

Location Details:

Hybrid Position Schedule /

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

Position Summary:

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.

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.

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

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:

Three years of experience or equivalent training in the following:negotiation of claim settlements securing and evaluating evidence preparing manual and electronic estimatessubrogation claims resolving coverage question staking 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 medical terminology and human anatomyMCCA 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…