Sr. Claim Specialist; Michigan Assigned Claim Unit

Job Overview

Sr. Claim Specialist (Michigan Assigned Claim Unit) – The Auto Club Group. Candidates must reside within a 50-mile radius of Dearborn, Michigan, as this position requires occasional in-person court appearances. This role involves handling highly complex technical issues and claims, with a high level of autonomy.

The Auto Club Group is seeking a Senior Claim Specialist who can work under less supervision with a high level of authority to handle highly complex technical issues and the most complex claims.

Responsibilities include:

• 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 coverage analysis on the most complex claims.
• Ensure all possible policyholder benefits are identified.
• Create additional sub-claims if needed.
• Investigate the facts regarding the claim to determine if the claim should be paid, 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).
• 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 MACP and catastrophic injuries (e.g., quadriplegic, traumatic brain injuries, amputations). The role requires proficiency in MACP and attorney-represented claims, coordination with insureds, physicians’ offices, and medical insurance carriers to obtain necessary information for review and determinations. They manage and resolve litigation files associated with PIP claims.

With our brand and mentoring, a Senior Claim Specialist can lead to a rewarding career at our growing organization.

This position is currently able to work remotely from a home office for day-to-day operations, with occasional travel for meetings, in-person court appearances, collaborative activities, or team-building activities as specified by leadership. This is subject to change based on amendments to the ACG Flex Work policy.

• A competitive annual salary between $85,321.60 and $95,000
• Medical, dental, and vision benefits
• 401k Match
• Paid parental leave and adoption assistance
• Paid Time Off (PTO), company holidays, CEO days, and floating holidays
• Paid volunteer day annually
• Tuition assistance and professional certification reimbursement
• AAA Membership
• Discounts and rewards

Education:

• Complete ACG Claim Representative Training Program or equivalent
• In states requiring an Adjuster’s license, eligible to acquire a State Adjuster’s license within 90 days of hire and maintain as required
• A valid driver’s license is required if in-person inspections or frequent in-person meetings are part of the role

Experience:

• Three years of experience or equivalent training in:
• Negotiation of complex Michigan claim settlements
• Securing and evaluating evidence
• Preparing manual and electronic estimates
• Subrogation claims
• Resolving complex coverage questions
• Taking statements
• Establishing clear evaluation and resolution plans for claims

Knowledge and

Skills:

• Essential Insurance Act (Michigan)
• Fair Trade Practices Act in relation to claims
• Subrogation procedures and processes
• Intercompany arbitration
• Litigation

• Negligence Law
• No-Fault Law
• Medical terminology and human anatomy
• MACP and attorney-represented claims

• Handle claims to the line Claim Handling Standards
• Follow and apply ACG Claim policies and guidelines
• Work within ACG Claim systems
• Perform basic claim file review and investigations
• Demonstrate effective verbal and written communication
• Provide customer service by building relationships with insureds/claimants
• Analyze and solve problems with sound decision making
• Priorit…