Executive Claims Specialist, PIP
Employment Information
Report this job
Job expired or something wrong with this job?
Job Description
Executive Claims Specialist providing technical oversight of PIP/no-fault claims for Crum & Forster’s specialty insurance programs. Auditing TPA claim handling, evaluating complex exposures and guiding litigation, arbitration and compliance.
Responsibilities:
- Provide senior-level technical oversight of PIP/no-fault claims administered by Third-Party Administrators
- Serve as a subject matter resource for PIP, including coverage, medical benefits, treatment disputes, medical necessities, peer reviews, IMEs, denials and regulatory requirements
- Provide technical guidance on complex, disputed, litigated and arbitrated PIP matters
- Evaluate coverage, benefit eligibility, priority of coverage and potential risk-transfer opportunities
- Review claim handling for accuracy, timeliness, documentation and statutory and regulatory compliance
- Partner with TPA claim professionals and leadership to address concerns and improve claim handling
- Conduct targeted claim audits and quality reviews
- Evaluate reserve adequacy and provide technical recommendations on complex exposures
- Identify trends involving providers, litigation, claim handling, leakage, compliance and emerging exposures
- Coordinate with Legal, SIU, medical review vendors, defense counsel and other partners
- Support enhancements to claim guidelines, workflows, reporting, training and quality controls
- Maintain awareness of legislative, regulatory and judicial developments affecting PIP/no-fault claims
Requirements:
- 6+ years of progressively responsible PIP/no-fault claims experience; 8–10 preferred
- Extensive hands-on New Jersey, New York and/or Pennsylvania no-fault experience strongly preferred
- Strong knowledge of medical management, coverage, treatment disputes, benefit denials and regulatory compliance
- Significant PIP litigation and arbitration experience
- Experience with TPA oversight, carrier technical claims, quality assurance or similar program oversight preferred
- Commercial auto experience
- Rideshare, transportation network company or sharing economy experience is a plus but not required
- Strong analytical, written and verbal communication skills
- Bachelor’s degree required
- CPCU, AIC, SCLA, law degree or other relevant professional designation is a plus
- Occasional travel may be required
Benefits:
- Competitive compensation package
- Generous 401K employer match
- Employee Stock Purchase plan with employer matching
- Generous Paid Time Off
- Health, dental and vision benefits
- Wellness programs focused on physical, mental and financial wellbeing
- Tuition reimbursement
- Industry-related certifications
- Professional training
- Dynamic, ambitious, fun and exciting work environment
- Matching donation program
- Volunteer opportunities
- Employee-driven corporate giving program
- Special accommodations and inclusive workplace support
Similar Jobs
Senior Claims Specialist
Senior Claims Specialist managing complex workers’ compensation claims for CorVel, a national risk-management solutions provider. Investigating claims, managing litigation and recoveries, and negotiating outcomes remotely in California.
Executive Claims Specialist, Bodily Injury
Executive Claims Specialist overseeing TPA-managed bodily injury, PIP, and property damage rideshare claims. Controlling litigation costs and improving claims outcomes for specialty insurer Crum & Forster.
Senior Claims Analyst
Senior Claims Analyst handling complex casualty and environmental insurance claims for One80 Intermediaries. Investigating coverage, managing litigation, and resolving claims remotely in Massachusetts.
Senior Workers Comp Claims Specialist
Senior Workers’ Compensation Claims Specialist managing complex California claims for National Interstate, a commercial transportation insurer. Fully remote from the USA, handling investigations, settlements, reserves, and litigation matters.
Claims Adjuster – Commercial Auto Claims
Claims Adjuster managing complex commercial auto, bodily injury, and physical damage claims. Supporting a world-class asset-based carrier’s safety, compliance, litigation, and vendor processes.
Senior Claims Representative – Transportation
Senior claims representative managing complex commercial auto claims for Berkley Small Business Solutions. Handling coverage, investigations, reserves, settlements, vendors, and mentoring across jurisdictions.
Cargo Claims Specialist
Cargo Claims Specialist processing cargo claims for Trinity Logistics’ freight operations. Providing solutions and customer-carrier claims expertise while working remotely.
Claims Examiner II
Claims Examiner II adjudicating healthcare claims for HealthEdge’s health insurance technology platform. Reviewing coding, coverage criteria, and system edits while mentoring team members.
Claims Examiner II
Claims Examiner II adjudicating healthcare claims for HealthEdge’s health insurance technology platform. Reviewing coding, coverage criteria, and payment accuracy while mentoring team members.
Claims Examiner – Workers Compensation, OR Cert Preferred
Remote workers compensation claims examiner adjudicating complex Oregon claims for Sedgwick. Investigating exposures, negotiating settlements, and communicating claim activity with clients and claimants.
Liability Claims Adjuster – Premises, Auto, Bodily Injury
Liability Claims Adjuster investigating and resolving auto and general liability claims for CCMSI, a third-party administrator. Managing bodily injury, premises, litigation, reserves, and settlements remotely.
Third Party Liability Claims Specialist
Third Party Liability Claims Specialist reviewing litigation accounts, liens, and settlements. Supporting Revecore’s hospital revenue recovery services through insurance and attorney coordination.
Claims Associate – Roofing, Property Claims
Remote Claims Associate coordinating inspections, dispatch, and communications for Hancock Claims Consultants’ residential and commercial property claims. Supporting fast-paced catastrophe events and policyholder service.
Crop Claims Representative, Northwest North Dakota
Crop claims representative assessing agricultural losses and settlements for Great American Insurance. Fully remote in Northwest North Dakota, with field inspections and up to 40% territory travel.
Crop Claims Representative
Remote crop claims representative evaluating agricultural claims for Great American Insurance in Eastern South Dakota. Investigating fields, determining settlements, and traveling up to 40% within the territory.
Crop Claims Representative – Eastern Iowa
Crop claims representative assessing Eastern Iowa farm insurance claims for Great American’s Crop Division. Investigating field losses, negotiating settlements, and traveling throughout the territory.
Field Claims Specialist
Field Claims Specialist investigating termite damage claims for Rentokil’s global pest-control services. Determining root causes, repair scopes, and timely claim resolutions.
Claims Analyst
Claims Analyst adjudicating medical, dental, vision, life, and disability claims for Luminare Health. Processing inquiries accurately under plan guidelines and turnaround requirements.
Claims Analyst
Claims Analyst adjudicating healthcare, life, and disability claims for Luminare Health. Processing inquiries and correspondence accurately under plan guidelines and turnaround requirements.
Workers Compensation Claims Representative – Medical Only, VA Jurisdiction
Workers compensation claims representative processing medical-only claims for Sedgwick, a global claims-management company. Adjudicating VA-jurisdiction claims, negotiating settlements, and communicating with claimants and clients.