Senior Personal Injury Protection Adjuster

FCIC•Chicago, IL

About The Position

As a Senior Personal Injury Protection ("PIP") Specialist, you will be responsible for evaluating and managing claims filed under the Personal Injury Protection ("PIP") coverage of commercial and personal insurance policies. You will investigate claims, assess injuries, negotiate settlements, and ensure compliance with relevant laws and regulations. Key Responsibilities Review and assess PIP claims to determine coverage, liability, and the extent of injuries. Conduct thorough investigation into the circumstances surrounding each claim, including obtaining medical records, police reports, and statements. Evaluate the nature and severity of injuries reported by first-party claimants through medical documentation, diagnostic tests, and expert opinions. Determine the applicability of PIP coverage based on policy terms, state regulations, and the specifics of each claim. Negotiate fair and equitable settlements with claimants, attorneys, and medical providers to resolve claims effectively. Maintain detailed and accurate records of claim files, including correspondence, investigation findings, settlement offers, and payment transactions. Communicate effectively with first-party claimants, legal representatives, medical providers, and other stakeholders to provide updates, address concerns, and facilitate the claims process. Ensure compliance with all relevant laws, regulations, and company policies throughout the claims handling process. Provide exceptional customer service to first-party claimants by addressing inquiries promptly and offering assistance throughout the claims process. Manage pre-authorization requests and identification of cases requiring an IME. Stay abreast of industry trends, legal developments, and medical advancements relevant to PIP claims to enhance expertise and effectiveness in the role. Complete a detailed analysis of claims where a new suit has been received inclusive of coverage, liability, and damages Manage and oversee litigation processes, working closely with legal counsel to develop strategies for case resolution

Requirements

Bachelor's degree or equivalent work experience
Previous experience in auto claim adjusting, preferably with a focus on commercial PIP claims in NJ and PA.
Previous experience with AICRA in New Jersey and MVFRL in PA.
Strong knowledge of insurance principles, coverage types, and regulations governing PIP
Excellent analytical skills with the ability to assess complex situations and make informed decisions
Effective negotiation skills and the ability to resolve conflicts and disputes
Exceptional communication skills, both verbal and written, and the ability to convey information clearly and concisely
Detail-Oriented with strong organizational and time management skills
Proficiency in relevant software applications for claims management and documentation

Nice To Haves

Previous litigation experience is preferred but not required.
Prior Non-Standard Auto Claims experience a plus, not required.

Responsibilities

Review and assess PIP claims to determine coverage, liability, and the extent of injuries.
Conduct thorough investigation into the circumstances surrounding each claim, including obtaining medical records, police reports, and statements.
Evaluate the nature and severity of injuries reported by first-party claimants through medical documentation, diagnostic tests, and expert opinions.
Determine the applicability of PIP coverage based on policy terms, state regulations, and the specifics of each claim.
Negotiate fair and equitable settlements with claimants, attorneys, and medical providers to resolve claims effectively.
Maintain detailed and accurate records of claim files, including correspondence, investigation findings, settlement offers, and payment transactions.
Communicate effectively with first-party claimants, legal representatives, medical providers, and other stakeholders to provide updates, address concerns, and facilitate the claims process.
Ensure compliance with all relevant laws, regulations, and company policies throughout the claims handling process.
Provide exceptional customer service to first-party claimants by addressing inquiries promptly and offering assistance throughout the claims process.
Manage pre-authorization requests and identification of cases requiring an IME.
Stay abreast of industry trends, legal developments, and medical advancements relevant to PIP claims to enhance expertise and effectiveness in the role.
Complete a detailed analysis of claims where a new suit has been received inclusive of coverage, liability, and damages
Manage and oversee litigation processes, working closely with legal counsel to develop strategies for case resolution