Senior Claim Specialist - PIP Litigation

A career at The Auto Club Group (ACG) can be satisfying, exciting and rewarding. By aligning your professional development with our business objectives, ACG can help you attain your career goals — and make a difference. Get started by choosing the career that’s right for you.

Southfield, MI

The Auto Club Group

AAA was founded over 100 years ago for the purpose of lobbying for driver and passenger rights, fair laws and safer vehicles — all to better promote the love of the open road and the adventure of driving. Since then, AAA has grown to over 50 million members strong, while providing valuable membership services such as roadside assistance. Additionally, AAA has broadened its horizons to include all types of travel-related services, as well as offer a variety of insurance and financial products and services. Today’s AAA is a national federation comprised of more than 50 individual clubs throughout the United States and Canada. Whether you’re traveling around the world or to the corner grocery store, planning a honeymoon or weekend road trip, learning to drive or in need of a battery boost, the best way to begin your journey is with AAA.

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Competitive Compensation and Benefits Package

Overview: he Auto Club Group (ACG) provides membership, travel, insurance and financial services offerings to approximately 9 million members and customers across 11 states and 2 U.S. territories through the AAA, Meemic and Fremont brands. ACG belongs to the national AAA federation and is the second largest AAA club in North America.&nbsp;<br /> <div><strong><u><br />&nbsp;Work Environment</u></strong></div> <p>Works in a temperature controlled office environment.&nbsp; Depending on line travel may be required to visit courts, attorney offices, patients, hospitals, rehabilitation centers, repair facilities, damaged homes, contractors, etc. per with exposure to road hazards and temperature extremes.&nbsp;<br /><br />The Auto Club Group offers a competitive compensation and benefits package including a base salary with performance based incentives; medical/dental/vision insurance, pension, 401(k), generous time off, a complimentary AAA Membership and much more!</p>
Responsibilities: <ul> <li>Work under less supervision with a high-level of authority to handle highly complex technical issues, complex PIP claims and litigated PIP claims.</li> <li>Claim handling responsibilities will include the following: reviewing assigned claims, contacting the insured and other affected parties, including Defense Counsel, setting expectations for the remainder of the claim process about key issues and goals, and initiating documentation in the claim handling system.&nbsp;&nbsp;</li> <li>Complete coverage analysis on the most complex claims. Ensure all possible policyholder benefits are identified.&nbsp;</li> <li>Create additional sub-claims if needed.&nbsp;</li> <li>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.&nbsp;</li> <li>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.</li> <li>Approve payments for the appropriate parties accordingly.&nbsp;</li> <li>Refer claims to other company units when necessary (e.g., Underwriting, Recovery Units or Claims Special Investigation Unit).&nbsp;</li> <li>Thoroughly document and/or code the claim file and complete all claim closure and related activities in the assigned claims management system.&nbsp;&nbsp;</li> <li>Utilize strong negotiating skills and ability to communicate with Defense Counsel.</li> <li>Senior Claim Specialists are assigned Liability/BI/MedPay/Non-MI PIP claims involving litigation/arbitration.&nbsp;</li> <li>Handle the most complex claims involving liability disputes, bodily injuries, and coverage questions.&nbsp;</li> <li>Senior Claims Specialists assigned to the PIP unit are responsible for claims involving the MCCA or quadriplegic, traumatic brain, amputations and other catastrophic injuries.</li> <li>The role will require proficiency in dealing with the MCCA and attorney represented claims.</li> <li>Work with insureds, physicians&rsquo; offices and medical insurance carriers to obtain necessary information to complete the claims review process and make the appropriate determinations.</li> </ul>
Requirements: <div><strong><u>Preferred Qualifications</u></strong></div> <div><u>Education:</u></div> <ul type="disc"> <li>Associate degree in Business Administration, Insurance or a related field or the equivalent in related work experience</li> <li>Completion of the Insurance Institute of America's: General Insurance Program, Associate in Claims, Associate in Management or equivalent</li> <li>CPCU coursework or designation</li> <li>Xactware Training</li> </ul> <div><strong><u>Required Qualifications (these are the minimum requirements to qualify)</u></strong></div> <div><strong><u>Education (include minimum education and any licensing/certifications):</u></strong></div> <ul type="disc"> <li>Complete ACG Claim Representative Training Program or demonstrate equivalent knowledge or experience</li> <li>In states where an Adjuster&rsquo;s license is required, the candidate must be eligible to acquire a State Adjuster&rsquo;s license within 90 days of hire and maintain as specified for appropriate states.</li> <li>Must have a valid State Driver's License</li> </ul> <div><u>Experience:</u></div> <ul type="disc"> <li>Five years of experience in the following:</li> <li>Negotiation of complex claim settlements</li> <li>Securing and evaluating evidence</li> <li>Preparing manual and electronic estimates</li> <li>Subrogation claims</li> <li>Resolving complex coverage questions</li> <li>Taking statements</li> <li>Establishing clear evaluation and resolution plans for claims</li> </ul> <div><u>Knowledge and Skills:</u></div> <ul type="disc"> <li>Advanced technical knowledge of &nbsp;</li> <li>Scheduling orders</li> <li>Essential Insurance Act (Michigan)</li> <li>Fair Trade Practices Act as it relates to claims</li> <li>Subrogation procedures and processes</li> <li>Intercompany arbitration</li> <li>Litigation management including attending depositions, arbitrations, settlement conferences, facilitations and trials</li> </ul> <div>Advanced technical knowledge of:</div> <ul type="disc"> <li>Negligence Law</li> <li>No-Fault Law</li> <li>Medical terminology and human anatomy</li> </ul> <div>Advanced technical knowledge of:</div> <ul type="disc"> <li>Negligence Law</li> <li>No-Fault Law</li> <li>Medical terminology and human anatomy</li> <li>MCCA and attorney represented claims</li> </ul> Important Note: The above statements describe the principal and essential functions, but not all functions that may be inherent in the job.&nbsp; This job requires the ability to perform duties contained in the job description for this position, including, but not limited to, the above requirements.&nbsp; Reasonable accommodations will be made for otherwise qualified applicants, as needed, to enable them to fulfill these requirements.