Senior Claim Specialist, Medical Management Unit

AAA

. Review assigned Michigan Personal Injury Protection (PIP) claims .

Posted 9/28/2026full-timeMichigan • United StatesSenior💰 $76,700 - $119,434 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 relevant laws. Proficient in claim documentation, evaluation, and settlement processes while maintaining strong communication and customer service skills.

Highest-signal resume keywords

Michigan Personal Injury Protection ClaimsNegotiation of Claim SettlementsAdvanced Knowledge of Essential Insurance ActClaim Documentation and EvaluationCustomer Service and Relationship-Building Skills

ATS Keywords

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Applicant Tracking System Keywords

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Hard Skills

Coverage AnalysisSubrogation ProceduresClaim File ReviewInvestigation SkillsMedical TerminologyNegligence LawNo-Fault LawClaim Handling StandardsTime-Sensitive Information ProcessingBasic PC Software Proficiency

Soft Skills

Effective Verbal CommunicationEffective Written CommunicationProblem-Solving SkillsSound Decision-Making SkillsTime Management Skills

Tools & Technologies

Claims Management SystemACG Claim Systems

Certifications & Qualifications

State Adjuster’s LicenseCompletion of ACG Claim Representative Training ProgramCompletion of Insurance Institute of America ProgramsCPCU Coursework

Industry Keywords

Fair Trade Practices ActIntercompany ArbitrationHandling Simple LitigationMCCAAttorney-Represented Claims

About the role

Key responsibilities & impact

Review assigned Michigan Personal Injury Protection (PIP) claims
Contact insureds and other affected parties and set expectations for the claim process
Initiate and maintain documentation in the claim handling system
Complete complex coverage analysis and identify all applicable policyholder benefits
Create additional sub-claims when needed
Investigate claim facts to determine payment, applicable limits or exclusions, and recovery potential
Review damages and determine applicability of state law and other claim-related factors
Evaluate the financial value of losses
Approve payments for appropriate parties
Refer claims to Underwriting, Recovery Units, Claims Special Investigation Unit, or other company units when necessary
Document and code claim files and complete closure and related activities in the claims management system
Negotiate claim settlements
Handle claims involving MCCA, quadriplegic injuries, traumatic brain injuries, amputations, and other catastrophic injuries
Work with insureds, guardians, conservators, attorneys, treatment teams, and case managers to obtain information and complete claim reviews
Make appropriate claim determinations
Occasionally travel for meetings, collaborative activities, or team-building activities as specified by leadership

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
Five 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)
Knowledge of the Fair Trade Practices Act as it relates to claims
Knowledge of subrogation procedures and processes
Knowledge of intercompany arbitration
Knowledge of handling simple litigation
Advanced knowledge of negligence law, No-Fault Law, No-Fault Reform, 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
Ability to travel outside assigned territory, potentially overnight
Ability to relocate and work evenings or weekends
Associate degree in Business Administration, Insurance, or a related field, or equivalent related work experience (preferred)
Completion of Insurance Institute of America programs, CPCU coursework, or designation (preferred)
Must consent to background and drug screening if offered employment

Benefits

Comp & perks

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
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)
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
Annual company bonus incentive
Remote work from a home office for day-to-day operations, subject to ACG Flex Work policy