Claims Specialist

BP&C•Omaha, NE

5h•Onsite

About The Position

The Claims Specialist is responsible for the end‑to‑end handling of Personal Injury Protection (PIP) and Medical Payment (Med Pay) claims across numerous jurisdictions, from initial investigation through resolution. Working with a high degree of autonomy, this role focuses on accurate coverage determination, compliance with state and federal regulations, as well as fair and timely claim outcomes. The Specialist manages moderate to high‑complexity PIP and Med Pay claims and collaborates closely with internal partners, medical providers, vendors, and defense counsel as needed. This is a 100% in -office position. Candidates must be able to work on-site at a designated company office during standard business hours.

Requirements

4 years of claims experience
Experience evaluating medical records, treatment plans, and claim disputes
Active adjuster license and ability to maintain required continuing education
Strong negotiation, analytical, and written communication skills

Nice To Haves

Bachelor’s degree in a related field or the equivalent work experience

Responsibilities

Investigate, evaluate, negotiate, and resolve PIP and Med Pay claims in compliance with state statutes, regulations, and case law
Handle PIP Arbitrations as necessary
Confirm coverage, review facts of loss, and assess injuries, treatment and medical necessity
Review and process medical bills, applying fee schedules, coding standards, and cost‑containment methodologies
Evaluate claim complexity and exposure; escalate or refer matters appropriately
Communicate directly with claimants, attorneys, medical providers, and vendors
Negotiate settlements and ensure proper documentation, releases, and regulatory timeframes
Identify and address coverage, liability, or fraud indicators when present
Maintain accurate claim documentation and meet regulatory and internal service standards