Sr. Claims Examiner - PIP and Bodily Injury Claims Adjuster

Core Specialty Insurance Holdings, Inc. • Dallas, TX

7d • Hybrid

About The Position

- This position will be primarily responsible for the direct handling of PIP claims with some secondary responsibility for light to moderate Auto Bodily Injury Claims. Primarily, this role should be able to address all claim issues by gathering information necessary to make informed and responsible decisions to bring these PIP claims to an appropriate resolution and occasionally, do the same for limited BI claims Key Accountabilities/Deliverables: Ensure compliance with established claim handling guidelines regarding coverage, investigation, liability, damages, evaluation, and resolution. Evaluating the nature and severity of PIP claims; reviewing 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 Negotiating by developing a PIP settlement strategy and negotiating with the claimant, their employer, and/or legal counsel. Keeping 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. Investigate commercial claims and 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. In addition to the above key responsibilities, you may be required to undertake other duties from time to time as the Company may reasonably require. Technical Knowledge and Understanding: Must be able to analyze Commercial Policy coverages, liability and damages Possess a comprehensive understanding and knowledge of state and federal laws (including legislation) applicable to PIP and Auto Bodily Injury claims. Possesses an in-depth understanding of the policy language/coverage applicable to Commercial Auto Garage and General Liability claims Ability to work independently, manage time and resources to accomplish multiple tasks in a fast paced, deadline-oriented environment Computer skills – good working knowledge of MS Office, Excel and WORD

Requirements

• Insurance adjuster’s license required.
• College degree or equivalent work experience required.
• Minimum of 5 years’ experience handling PIP claims required
• 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.
• Applicants must be authorized to work for any employer in the U.S. We are unable to sponsor or take over sponsorship of an employment Visa for this position.
• Must be able to analyze Commercial Policy coverages, liability and damages
• Possess a comprehensive understanding and knowledge of state and federal laws (including legislation) applicable to PIP and Auto Bodily Injury claims.
• Possesses an in-depth understanding of the policy language/coverage applicable to Commercial Auto Garage and General Liability claims
• Ability to work independently, manage time and resources to accomplish multiple tasks in a fast paced, deadline-oriented environment
• Computer skills – good working knowledge of MS Office, Excel and WORD

Nice To Haves

• PIP litigation handling preferred
• Experience handling Bodily Injury claims preferred

Responsibilities

• Ensure compliance with established claim handling guidelines regarding coverage, investigation, liability, damages, evaluation, and resolution.
• Evaluating the nature and severity of PIP claims; reviewing 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
• Negotiating by developing a PIP settlement strategy and negotiating with the claimant, their employer, and/or legal counsel.
• Keeping 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.
• Investigate commercial claims and 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.

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, and a wellness program

What This Job Offers

• Job Type: Full-time
• Career Level: Mid Level
• Number of Employees: 1,001-5,000 employees