No-Fault (PIP) Senior Adjuster

HEREFORD INSURANCE COMPANY•New York, NY

1d•Hybrid

About The Position

We are seeking an experienced Senior No-Fault Adjuster with extensive knowledge of New York No-Fault/PIP claims handling. The ideal candidate will possess a minimum of 5 years of New York No-Fault claims experience and demonstrate strong investigative, analytical, and organizational skills. This position requires the ability to independently manage complex claims, interpret New York No-Fault regulations, evaluate medical documentation, address coverage issues, and effectively communicate with providers, attorneys, insureds, and internal departments. Experience handling claims involving transportation network, livery, black car, taxi, or for-hire vehicle exposures is strongly preferred. Familiarity with Workers’ Compensation and Black Car Fund-related coverage issues is also highly desirable, particularly where questions arise regarding primary coverage determinations between Workers’ Compensation and No-Fault benefits.

Requirements

Minimum of 5 years of New York No-Fault/PIP claims handling experience.
Strong working knowledge of New York No-Fault regulations and claim handling requirements.
Experience managing complex No-Fault claims independently.
Knowledge of arbitration and litigation processes related to No-Fault claims.
Excellent written and verbal communication skills.
Strong organizational skills and ability to manage deadlines in a fast-paced environment.
Proficiency with claim management systems and Microsoft Office applications.

Nice To Haves

Experience handling for-hire vehicles, livery, taxi, rideshare, or transportation-related claims.
Familiarity with Workers’ Compensation claims handling and Workers’ Compensation Board procedures.
Experience addressing Black Car Fund coverage and priority disputes.
Knowledge of transfer of coverage and reimbursement recovery processes between No-Fault and Workers’ Compensation carriers.
SIU/fraud investigation exposure.

Responsibilities

Independently manage a pending inventory of New York No-Fault/PIP claims from inception through resolution.
Review and evaluate medical bills, lost wage claims, and supporting documentation for compensability and compliance with New York No-Fault regulations.
Issue timely claim determinations, denials, verification requests, and payment authorizations in accordance with statutory timeframes.
Investigate and evaluate coverage issues, including priority of coverage and policy applicability.
Review police reports, EUO transcripts, IME reports, medical records, wage documentation, and provider submissions.
Coordinate and monitor Examinations Under Oath (EUOs), Independent Medical Examinations (IMEs), and peer reviews.
Identify potential fraud indicators and refer suspicious claims for SIU investigation when appropriate.
Maintain accurate claim documentation and detailed file notes.
Handle claims involving overlapping No-Fault and Workers’ Compensation exposure.
Review and assess claims where Workers’ Compensation or the Black Car Fund may be primary for medical and wage benefits.
Coordinate with Workers’ Compensation carriers, attorneys, employers, and the New York State Workers’ Compensation Board regarding compensability and coverage determinations.
Evaluate the impact of Workers’ Compensation Board decisions on No-Fault exposure and reimbursement rights.
Identify and pursue transfer of responsibility when Workers’ Compensation is deemed primary.
Communicate professionally and effectively with insureds, claimants, attorneys, medical providers, brokers, and internal departments.
Respond timely to inquiries and maintain strong customer service standards.
Provide guidance and mentorship to junior adjusters and support staff as needed.
Follow any other job-related instructions and to perform other job-related duties as requested by your supervisor.