Remote Medical Claims Processor Jobs in Detroit, MI

Job Type:

Job Description:

Location Details:

Detroit, Michigan

Chicago, Illinois

Position Schedule / Shift:

Hybrid- Field schedule Monday - Friday: 8:30 AM EST - 5:30 PM EST. Some weekend hours may be required based on work assignments.

Position Summary:

Make a meaningful impact when people need it most. As a Catastrophe Field Claims Specialist, you'll be on the front lines helping customers recover after catastrophic events by conducting on-site inspections, evaluating damage, and guiding them through the claims process. This dynamic role combines problem-solving, relationship-building, and travel, offering the opportunity to deliver exceptional service while helping communities rebuild and move forward.

Key Responsibilities:

• Reviewing assigned claims

• Contacting the insured and other affected parties

• Setting expectations for the remainder of the claim process, and initiating documentation in the claim handling system

• Complete complex coverage analysis

• Ensure all possible policyholder benefits are identified

• Create additional sub-claims if needed

• Complete an investigation of the facts regarding the claim to further and in more detail determine if the claim should be paid the applicable limits or exclusions and possible recovery potential

• Conduct thorough reviews of damages and determine the applicability of state law and other factors related to the claim

• Evaluate the financial value of the loss

• Approve payments for the appropriate parties accordingly.

• Refer claims to other company units when necessary (e.g., Underwriting, Recovery Units or Claims Special Investigation Unit)

• Thoroughly document and/or code the claim file and complete all claim closure and related activities in the assigned claims management system

• Utilize strong negotiating skills

• Claim Specialists assigned to Homeowner/CAT claim unit handle claims valued over $25,000 (for the inside desk role) and over $100,000 (for field role)

• Investigate claims requiring in-depth coverage analysis

• When handling claims in the field, must prepare damage estimates using claims software

• Review estimates for accuracy

• May monitor contractor repair status

• May assist Claim Manager with file reviews and training

Qualifications:

Required

Education:

• 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.

• Must have a valid State Driver's License

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 and Skills:

• 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

• Building construction and repair techniques

Ability to:

• 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 workload 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

• Relocate, work evenings or weekends

Preferred

Education:

• 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 degree in claims, Associate degree in management or equivalent

• CPCU coursework or designation

• Xactware Training

• 1-2 years of full cycle homeowners claims handling experience

• Experience handling personal property and additional living expense claims

• Experience with internal water loss, fire, and smoke claims

Ability to:

• Walk on roofs

• Climb ladders

• Lift up to 25 pounds

Work Environment:

This position is currently able to work remotely from a home office location for day-to-day operations, with traveling to field locations as necessary to complete job responsibilities, unless occasional team building activities are 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 Catastrophe Field Claim Specialist earns a competitive annual salary of $70,000.00- $89,000.00, along with the opportunity for an annual company bonus incentive and additional catastrophe unit specific compensation.

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 August 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 www.aaa.com

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.