Michigan Claim Specialist—Medical Management Unit MMU

Job Type: Full time Exempt/Non Exempt: Salary Job Description: Job Description Location Details: Hybrid Position Schedule / Shift: Monday-Friday 8am-5pm ET Position Summary: As a Claim Specialist, you will evaluate coverage, assess claim exposures, and make informed decisions that drive fair and timely resolutions. Working closely with members, medical providers, attorneys, and internal partners under minimal supervision, you'll manage challenging and complex claim scenarios while ensuring compliance with applicable regulations and company standards. The ideal candidate will have experience interpreting and applying Michigan No-Fault reform regulations to support accurate claim handling and benefit determinations. This role is ideal for a detail-oriented professional who thrives on problem-solving, sound judgment, and delivering positive outcomes for members. Key Responsibilities: Review assigned claims and initiate claim handling activities. Contact insureds and other affected parties to gather information and set expectations for the claims process. Document claim activity and maintain accurate records within the claims management system. Perform complex coverage analysis and identify all applicable policyholder benefits. Establish and manage sub-claims as needed. Conduct thorough investigations to determine coverage applicability, claim validity, policy limits, exclusions, and recovery opportunities. Analyze claim facts, damages, state laws, and other relevant factors impacting claim decisions. Evaluate the financial value of losses and authorize appropriate claim payments. Negotiate settlements and claim resolutions using strong negotiation skills. Refer claims to specialized departments when necessary, including Underwriting, Recovery Units, and the Claims Special Investigation Unit (SIU). Ensure complete and accurate claim documentation, coding, closure activities, and compliance with company procedures. Handle intermediate to complex Michigan Personal Injury Protection (PIP) claims, including: Fractures Mild closed head injuries Surgical procedures Attendant care claims Manage claims involving the Michigan Catastrophic Claims Association (MCCA). Handle attorney-represented claims and effectively navigate legal involvement throughout the claim process. Investigate and manage losses that may extend beyond standard PIP claim scenarios. Collaborate with insureds, physician offices, medical providers, and insurance carriers to obtain necessary documentation and information. Review medical and claim-related information to make accurate coverage and payment determinations. Maintain compliance with applicable state regulations, company policies, and claim handling standards. 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: Three 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 of: Advanced knowledge of: Essential Insurance Act (Michigan) Fair Trade Practices Act as it relates to claims Subrogation procedures and processes Intercompany arbitration Handling simple litigation Negligence Law No-Fault Law 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 and maintaining relationships with insureds/claimants while exhibiting understanding of their problems and responding to questions and concerns Analyze and solve problems while demonstrating sound decision making skills Prioritize claim related functions Process time sensitive data and information from multiple sources Manage time, organize and plan work load and responsibilities Safely operate a motor vehicle in order to visit repair facilities, homes (for inspections), patients, etc. Research analyze and interpret subrogation laws in various states Travel outside of assigned territory which may involve overnight stay Work evenings or weekends Preferred Education: Bachelor’s degree or equivalent in Business Administration, Human Resources Management, or related field Experience: Associate degree in Business Administration, Insurance or a related field or the equivalent in related work experience Completion of the Insurance Institute of America's: General Insurance Program, Associate in Claims, Associate in Management, or equivalent CPCU coursework or designation Work Environment: This position is currently able to work remotely from a home office location for day-to-day operations unless occasional travel for meetings, collaborative activities, or team building activities is specified by leadership. This is subject to change based on amendments and/or modifications to the ACG Flex Work policy. Compensation & Benefits Overview: ACG complies with all applicable state and local laws regarding required benefits (including PTO, paid sick leave, etc.). Compensation A Claim Specialist earns a competitive annual salary of $67,371.20-$104,811.20 along with the opportunity for an annual company bonus incentive. Benefits At ACG, we offer a comprehensive and flexible benefits package designed to support your health, financial well-being, and professional growth. Health & Wellness Medical plans with multiple coverage options, including HSA eligibility. Prescription drug coverage. Dental and vision benefits. Employee Assistance Program (confidential support services). Financial Protection & Insurance 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. Retirement & Savings 401(k) plan to support long-term financial goals. 3% automatic deferral upon eligibility; may contribute 1% to 50% of eligible earnings, either pre or post tax. Company match of 50% paid on employee contributions up to 6% of pay, payable to employees following the end of the year; immediate vesting. Additional company contribution of 4% of pay each pay day into your account; 100% vested after three (3) years of service. Health Savings Account (HSA) and Flexible Spending Accounts (FSA) options. Time Off & Leave Paid Time Off (PTO): Accrual-based, increases with tenure, eligible at 90 days of employment. Full-time new employees will receive up to 12 PTO days annually; accrual based on start date and may include additional PTO based on role and/or state & local requirements. Part-time employee PTO hours are calculated based upon the standard weekly hours the employee is scheduled to work and will accrue at a minimum of 3 hours per month. Paid Holidays: Full-time employees are eligible for 10 company-paid holidays annually, in addition to 1 mental health day, 2 floating holidays and 1 volunteer day. Holidays vary by business unit schedules. Part-time employees are eligible for 8 company-paid holidays annually, in addition to 1 mental health day and 2 floating holidays. Holidays vary by business unit schedules. ​Paid leave programs, including parental, bereavement, jury duty, and military leave. Career Growth & Education 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. Additional Perks Complimentary AAA membership with roadside assistance and travel discounts. Adoption assistance program. Job Posting Period: This position is expected to remain posted through September 30, 2026, however, it may close at any time once a qualified candidate pool is identified. Who We Are Become a part of something bigger. The Auto Club Group (ACG) provides membership, travel, insurance, and financial service offerings to approximately 14+ million members and customers across 14 states and 2 U.S. territories through AAA, Meemic, and Fremont brands. ACG belongs to the national AAA federation and is the second largest AAA club in North America. By continuing to invest in more advanced technology, pursuing innovative products, and hiring a highly skilled workforce, AAA continues to build upon its heritage of providing quality service and helping our members enjoy life’s journey through insurance, travel, financial services, and roadside assistance. And when you join our team, one of the first things you’ll notice is that same, whole-hearted, enthusiastic advocacy for each other. We have positions available for every walk of life! AAA prides itself on creating an inclusive and welcoming environment of diverse backgrounds, experiences, and viewpoints, realizing our differences make us stronger. To learn more about AAA The Auto Club Group visit Important Note: ACG’s Compensation philosophy is to provide a market-competitive structure of fair, equitable and performance-based pay to attract and retain excellent talent that will enable ACG to meet its short and long-term goals. ACG utilizes a geographic pay differential as part of the base salary compensation program. Pay ranges outlined in this posting are based on the various ranges within the geographic areas which ACG operates. Salary at time of offer is determined based on these and other factors as associated with the job and job level. The above statements describe the principal and essential functions, but not all functions that may be inherent in the job. This job requires the ability to perform duties contained in the job description for this position, including, but not limited to, the above requirements. Reasonable accommodations will be made for otherwise qualified applicants, as needed, to enable them to fulfill these requirements. The Auto Club Group, and all its affiliated companies, is an equal opportunity employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, gender identity, sexual orientation, national origin, disability or protected veteran status. Regular and reliable attendance is essential for the function of this job. AAA The Auto Club Group is committed to providing a safe workplace. Every applicant offered employment within The Auto Club Group will be required to consent to a background and drug screen based on the requirements of the position.