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Personal Injury Protection (PIP) Adjuster
Posted 25 days agoViewed
💎 Seniority level: Middle, 3 years
🔍 Industry: Insurtech
🏢 Company: Reserv👥 101-250💰 $20,000,000 Series A over 1 year agoConsultingFinancial ServicesInsurance
🗣️ Languages: English
⏳ Experience: 3 years
Requirements:
- Minimum of 3 years of experience on point and concentrated in Personal Injury Protection, ideally experience with: Handling the states of NY / NJ / and MI MI / FL and/or KY
- Handling of commercial or ride share policies is highly preferred
- Subrogation referrals
- Bodily Injury and coordination of benefits between PIP and UM / UIM.
- Arbitration and or formal PIP/MP litigation
- Have active adjuster license(s) and be willing to obtain all licenses within 45 days, including completing state required testing
- Knowledge of state regulations, policy provisions, and standard operating procedures
- Ability to analyze and evaluate complex data and make sound decisions based on established guidelines, policies, and procedures
- Curious and motivated by problem solving and questioning the status quo
- Desire to engage in learning opportunities and continuous professional development
- Willingness to travel for client and claims needs
Responsibilities:
- Provide prompt, courteous and high-quality customer service to all policyholders and claimants by answering customer calls, filing claims, and resolving customer requests
- Investigate PIP / MP claims to determine coverage, extent of injury and evaluate medical billing for necessity and relatedness to the claim
- Gather relevant documentation, interview involved parties, explain policy, coverage, and appropriate course of action and resolve related medical expenses
- Assess the validity of PIP claims based on collected evidence, medical records, and applicable laws. Determine the appropriate settlement amount if appropriate, ongoing plan for resolution and recommend further action if necessary
- Manage an inventory of claims, establish initial reserves for all potential exposures, and adjust as appropriate throughout the claim
- Ensure compliance with specific state regulations, policy provisions, and standard operating procedures
- Maintain regular communication with claimants, policyholders, attorneys, medical providers, and other relevant parties to provide updates on claim status, request additional information, and facilitate the claims process within approved payment authority
- Prepare thorough and accurate claim reports, including detailed summaries of investigation findings, evaluation of damages, and rationale for claim decisions
- Provide input for continuous development of claims guidelines, best practices, and process improvements
- Oversee and direct outside investigative service providers and work closely with the client and client counsel and investigative services to resolve the claim
- Engage in learning opportunities to build knowledge of commercial lines claims, court decisions impacting the claims function, current guidelines in claims function, and policy changes and modifications
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