Michigan Catastrophic Claims Association
Senior Claims Examiner
General Summary
Reviews claims from member insurance companies to ensure proper claims management practices are followed in accordance with Michigan’s No-Fault law and MCCA policies and procedures. Determines reserve amounts for assigned claims. Works closely with member insurance companies to ensure compliance with reporting policies and procedures throughout the lifetime of the claim.
Essential Functions
- Reviews and approves requests for reimbursement on complex Michigan PIP claim files. Gathers supporting documentation for assigned claim files. Determines reserve amounts for claims in accordance with MCCA policies and procedures.
- Approves requests for authority from member companies. Consults with Claims Supervisor on complex or escalated requests for authority. May consult with legal counsel, may be responsible for claims in litigation, and may need to attend legal proceedings.
- Evaluates, monitors, and resolves ongoing requests for reimbursement and reviews semi-annual claim status reports prepared by member companies. Responds to questions related to claim status, Association procedures and other matters. Ensures claims are paid in accordance with Michigan no-fault law.
- Proactively assists member companies with compliance with MCCA claims policies and procedures, including MMS based and on-site audits of carrier claim files as needed.
- Stays abreast of Michigan no-fault law.
- Serves as a key resource and conducts training for member companies regarding the provisions of the Michigan No-Fault Law.
- Works with legal counsel to assist with resolution of disputed claims.
- Attends and participates in Claim Committee meetings as necessary.
- Prepares reports to present at round table discussions.
- Assists in the training of new employees.
- Participates in audits of Member companies for compliance with operating procedures.
An employee in this position may be called upon to do any or all of the above tasks. (These examples do not include all of the tasks which the employees may be expected to perform.)
Employment Qualifications
Education
Bachelor’s Degree in business, finance, insurance or closely related area, or equivalent training and experience required.
Experience
§ Five to seven years experience in Michigan PIP handling required.
§ Two years of catastrophic medical claims handling preferred.
§ Quality assurance auditing experience preferred.
Other Requirements
Proficiency in the use of common office software, including electronic spreadsheets, word processing programs, and e-mail systems required.
The qualifications listed above are intended to represent the minimum skills and experience levels associated with performing the duties and responsibilities contained in this job description. The qualifications should not be viewed as expressing absolute employment or promotional standards, but as general guidelines that should be considered along with other job-related selection or promotional criteria.
Physical Requirements (This job requires the ability to perform the essential functions contained in this description. These include, but are not limited to, the following requirements. Reasonable accommodations will be made for otherwise qualified applicants unable to fulfill one or more of these requirements.)
§ Ability to enter and retrieve information from a computer.
§ Ability to travel to and from member sites to perform claim file audits.
§ Ability to lift and carry files, laptop, and other materials.
§ Ability to travel to various sites.
Working Conditions
§ Works in an office environment, primarily remotely.
§ Travels to various sites to attend meetings and required court proceedings.
§ May be required to travel to various sites to conduct file audits.
Benefits:
- 401(k) matching
- Dental insurance
- Health insurance
- Life insurance
- Paid time off
- Vision insurance
Work Location: Hybrid remote in Livonia, MI 48152
