Senior Claims Examiner – PIP, Bodily Injury Claims Adjuster
Core Specialty Insurance Holdings, Inc.
full-time
Posted on:
Location Type: Remote
Location: Texas • United States
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Job Level
About the role
- Responsible for the direct handling of PIP claims with some secondary responsibility for light to moderate Auto Bodily Injury Claims.
- Address all claim issues by gathering information necessary to make informed and responsible decisions to bring these PIP claims to an appropriate resolution.
- Ensure compliance with established claim handling guidelines regarding coverage, investigation, liability, damages, evaluation, and resolution.
- Evaluate the nature and severity of PIP claims; review medical bills, lost wages, and other expenses to determine if the insured is eligible for coverage based on policy terms, state regulations, and the specifics of each claim.
- Negotiate by developing a PIP settlement strategy and negotiating with the claimant, their employer, and/or legal counsel.
- Keep track of your PIP log to ensure proper medical payments are made by the coverage available.
- Utilize critical thinking and solid judgment to solve problems, make decisions and resolve issues inherent in handling PIP and Bodily Injury losses, as well as plan and organize activities throughout the claim’s management process.
- Draft declination, Reservation of Rights and other coverage letters.
- Establish reserves pursuant to established reserving protocols and reserve authority procedures.
- Investigate commercial claims, while following corporate standards and guidelines.
- Communicate with policyholders, and third-party claimants to reach fair and reasonable settlements.
- Review and negotiate material damage appraisals with mechanics, repair shops or similar vendors.
Requirements
- Insurance adjuster’s license required
- College degree or equivalent work experience required
- Minimum of 5 years’ experience handling PIP claims required
- PIP litigation handling preferred
- Experience handling Bodily Injury claims preferred
- Ability to Travel occasionally
- Ability to negotiate and be persuasive.
- Must be detail-oriented to maintain accurate records of payment transactions, settlement offers, etc.
- Possess effective oral and written communication skills.
- Strong time-management skills, as some tasks will be time sensitive.
Benefits
- medical, dental, vision, and life insurances
- short and long-term disability
- a Company-match of 100% of a 6% contribution 401(k) plan
- an Employee Assistance Plan
- Health Savings Account
- Flexible Spending Account
- Health Reimbursement Account
- wellness program
Applicant Tracking System Keywords
Tip: use these terms in your resume and cover letter to boost ATS matches.
Hard Skills & Tools
PIP claims handlingBodily Injury claims handlingnegotiationclaims evaluationclaims investigationsettlement strategy developmentdrafting coverage lettersreserving protocolsmedical bill reviewloss assessment
Soft Skills
critical thinkingproblem solvingdecision makingorganizationattention to detailoral communicationwritten communicationpersuasivenesstime managementinterpersonal skills
Certifications
Insurance adjuster’s license