Claim Specialist

AAA

. Evaluate coverage, assess claim exposures, and make informed decisions for fair and timely resolutions .

Posted 9/28/2026full-timeMichigan • United StatesMid-LevelSenior💰 $67,371 - $104,811 per yearWebsite

Core Competencies

Role fit

Core Competencies

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Demonstrates advanced knowledge of Michigan Personal Injury Protection claims, including negotiation, coverage analysis, and compliance with state regulations. Proficient in managing complex claims, collaborating with various stakeholders, and maintaining accurate documentation within claims management systems.

Highest-signal resume keywords

Michigan Personal Injury Protection Claims ManagementNegotiation of Claim SettlementsAdvanced Knowledge of Essential Insurance ActEffective Verbal and Written Communication SkillsTime Management and Organization Skills

ATS Keywords

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Applicant Tracking System Keywords

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Hard Skills

Claims EvaluationCoverage AnalysisSubrogation ProceduresClaim DocumentationClaims Management System ProficiencyMedical TerminologyLegal Involvement in ClaimsLoss Value EvaluationClaim Payment AuthorizationInvestigation of Claim Validity

Soft Skills

Customer Service SkillsRelationship-Building SkillsProblem-Solving SkillsSound Decision-Making SkillsWorkload Planning Skills

Tools & Technologies

ACG Claim SystemsBasic PC Software

Certifications & Qualifications

State Adjuster’s LicenseACG Claim Representative Training Program

Industry Keywords

Fair Trade Practices ActNegligence LawNo-Fault LawMCCAClaim Handling Standards

About the role

Key responsibilities & impact

Evaluate coverage, assess claim exposures, and make informed decisions for fair and timely resolutions
Manage challenging and complex claims involving members, medical providers, attorneys, and internal partners
Review assigned claims and initiate claim-handling activities
Contact insureds and affected parties to gather information and set expectations
Document claim activity and maintain accurate records in the claims management system
Perform complex coverage analysis and identify applicable policyholder benefits
Establish and manage sub-claims
Investigate coverage applicability, claim validity, policy limits, exclusions, and recovery opportunities
Analyze claim facts, damages, state laws, and other factors affecting claim decisions
Evaluate loss values and authorize appropriate claim payments
Negotiate settlements and claim resolutions
Refer claims to Underwriting, Recovery Units, and the Claims Special Investigation Unit when necessary
Complete claim documentation, coding, closure activities, and compliance processes
Handle intermediate to complex Michigan Personal Injury Protection claims, including fractures, mild closed head injuries, surgical procedures, and attendant care claims
Manage claims involving the Michigan Catastrophic Claims Association
Handle attorney-represented claims and legal involvement throughout the claim process
Investigate and manage losses extending beyond standard PIP scenarios
Collaborate with insureds, physician offices, medical providers, and insurance carriers to obtain documentation and information
Review medical and claim-related information to determine coverage and payments
Maintain compliance with state regulations, company policies, and claim-handling standards

Requirements

What you’ll need

Complete ACG Claim Representative Training Program or demonstrate equivalent knowledge or experience
Eligible to acquire a State Adjuster’s license within 90 days of hire where required and maintain it as specified
Valid driver's license required if responsibilities involve in-person inspections or frequent in-person meetings
Three years of experience or equivalent training in negotiation of claim settlements, securing and evaluating evidence, preparing manual and electronic estimates, subrogation claims, resolving coverage questions, taking statements, and establishing evaluation and resolution plans
Advanced knowledge of Essential Insurance Act (Michigan), Fair Trade Practices Act as it relates to claims, subrogation procedures, intercompany arbitration, simple litigation, Negligence Law, No-Fault Law, medical terminology and human anatomy, MCCA and attorney-represented claims
Ability to handle claims to Claim Handling Standards and apply ACG Claim policies, procedures and guidelines
Ability to work within ACG Claim systems and basic PC software
Basic claim file review and investigation skills
Effective verbal and written communication skills
Customer service and relationship-building skills
Problem-solving and sound decision-making skills
Ability to prioritize claim-related functions and process time-sensitive information from multiple sources
Time management, organization and workload planning skills
Ability to safely operate a motor vehicle for visits to repair facilities, homes, patients, and other locations
Ability to research, analyze and interpret subrogation laws in various states
Willingness to travel outside assigned territory, potentially overnight
Ability to work evenings or weekends
Background and drug screen required upon employment offer

Benefits

Comp & perks

Annual company bonus incentive
Medical plans with multiple coverage options, including HSA eligibility
Prescription drug coverage
Dental and vision benefits
Employee Assistance Program
Company-paid basic life insurance
Optional supplemental life insurance and dependent coverage
Short-term and long-term disability coverage
Critical illness, accident, and pet insurance options
401(k) plan
3% automatic deferral upon eligibility
Company match of 50% on employee contributions up to 6% of pay
Additional company contribution of 4% of pay each pay day; 100% vested after three years of service
Health Savings Account and Flexible Spending Accounts options
Paid Time Off (PTO), increasing with tenure
Up to 12 PTO days annually for full-time new employees
10 company-paid holidays annually for full-time employees
1 mental health day, 2 floating holidays and 1 volunteer day for full-time employees
Paid leave programs, including parental, bereavement, jury duty, and military leave
Tuition assistance up to $5,250 annually; 80% covered by ACG
Professional certification support with 100% reimbursement for eligible programs
Opportunities for career development and advancement
Complimentary AAA membership with roadside assistance and travel discounts
Adoption assistance program
Remote work from a home office for day-to-day operations, subject to the ACG Flex Work policy