Senior PIP Litigation Claim Specialist - Michigan

Job Type:

Full timeSalary

Job Description:

 

Location Details:

Hybrid

Position Schedule / Shift:

Monday-Friday 8am-5:30pm ET

Position Summary:

Join AAA – The Auto Club Group as a Senior 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.

Senior Claims Specialists assigned to the PIP unit are responsible for claims involving the MCCA or quadriplegic, traumatic brain, amputations and other catastrophic injuries. The role will require proficiency in dealing with the MCCA and attorney represented claims. Work with insureds, guardians, conservators, attorneys, treatment teams and case managers 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:

• Five 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

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

• No-Fault Reform

• medical terminology and human anatomy

• MCCA 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 written)

• demonstrate customer service skills by building a