Claim Specialist, Michigan PIP

AAA

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

Posted 10/8/2026full-timeMichigan • United StatesMid-LevelSenior💰 $67,371 - $104,811 per yearWebsite

Core Competencies

Role fit

Core Competencies

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Demonstrates expertise in managing complex claims, including Michigan Personal Injury Protection claims, while ensuring compliance with state regulations and company policies. Proficient in negotiation, coverage analysis, and effective communication with insureds and medical providers.

Highest-signal resume keywords

Michigan Personal Injury Protection Claims ManagementNegotiation of Claim SettlementsAdvanced Knowledge of Essential Insurance ActACG Claim Representative Training ProgramState Adjuster’s License Eligibility

ATS Keywords

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Applicant Tracking System Keywords

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Hard Skills

Claim Evaluation and ResolutionCoverage AnalysisClaims Documentation and CodingSubrogation ProceduresLegal Involvement NavigationMedical Terminology and Human AnatomyTime-Sensitive Information ProcessingClaim File Review and InvestigationLoss Value EvaluationSettlement Negotiation

Soft Skills

Effective Verbal and Written CommunicationCustomer Service SkillsRelationship-Building SkillsProblem-Solving SkillsTime Management Skills

Tools & Technologies

Claims Management SystemBasic PC Software

Certifications & Qualifications

State Adjuster’s LicenseCompletion of Insurance Institute of America ProgramsCPCU Coursework or Designation

Industry Keywords

Fair Trade Practices ActNo-Fault LawMCCAIntercompany ArbitrationNegligence LawClaim 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 as needed
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 navigate legal involvement
Investigate and manage losses extending beyond standard PIP scenarios
Collaborate with insureds, physician offices, medical providers, and insurance carriers to obtain documentation
Review medical and claim-related information for coverage and payment determinations
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 duties 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 claim evaluation and resolution plans
Advanced knowledge of the 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 according to Claim Handling Standards
Ability to follow and apply ACG Claim policies, procedures, and guidelines
Ability to work within assigned 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 with insureds and claimants
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, and patients
Ability to research, analyze, and interpret subrogation laws in various states
Ability to travel outside the assigned territory, potentially overnight
Ability to work evenings or weekends
Preferred: Bachelor’s degree or equivalent in Business Administration, Human Resources Management, or related field
Preferred: Associate degree in Business Administration, Insurance, or related field, or equivalent related work experience
Preferred: Completion of Insurance Institute of America programs, Associate in Claims, Associate in Management, or equivalent
Preferred: CPCU coursework or designation

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
50% company match on employee contributions up to 6% of pay; immediate vesting
Additional company contribution of 4% of pay each pay day; 100% vested after three years of service
Health Savings Account (HSA) and Flexible Spending Accounts (FSA) options
Paid Time Off (PTO), increasing with tenure
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
Career development and advancement opportunities
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 policy and occasional travel requirements