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Reserv · 4 weeks ago

Personal Injury Protection (PIP) Adjuster

United States

Full-time

Remote

Mid Level

3+ years exp

Reserv is an insurtech focused on automating claims processes through AI and technology. They are seeking a detail-oriented Personal Injury Protection Resolution Specialist who will be responsible for investigating and evaluating PIP claims, providing exceptional customer service, and collaborating with product and engineering teams to enhance processes.

ConsultingFinancial ServicesInsurance

Responsibilities

Provide prompt, courteous and high-quality customer service to all policyholders and claimants by answering customer calls, filing claims, and resolving customer requests

Investigate PIP / MP claims to determine coverage, extent of injury and evaluate medical billing for necessity and relatedness to the claim

Gather relevant documentation, interview involved parties, explain policy, coverage, and appropriate course of action and resolve related medical expenses

Assess the validity of PIP claims based on collected evidence, medical records, and applicable laws. Determine the appropriate settlement amount if appropriate, ongoing plan for resolution and recommend further action if necessary

Manage an inventory of claims, establish initial reserves for all potential exposures, and adjust as appropriate throughout the claim

Ensure compliance with specific state regulations, policy provisions, and standard operating procedures

Maintain regular communication with claimants, policyholders, attorneys, medical providers, and other relevant parties to provide updates on claim status, request additional information, and facilitate the claims process within approved payment authority

Prepare thorough and accurate claim reports, including detailed summaries of investigation findings, evaluation of damages, and rationale for claim decisions

Provide input for continuous development of claims guidelines, best practices, and process improvements

Oversee and direct outside investigative service providers and work closely with the client and client counsel and investigative services to resolve the claim

Engage in learning opportunities to build knowledge of commercial lines claims, court decisions impacting the claims function, current guidelines in claims function, and policy changes and modifications

Qualification

Personal Injury ProtectionAdjuster licenseClaims investigationSubrogation referralsBodily Injury coordinationCommercial claims experienceAnalytical skillsCustomer serviceCommunication skillsProblem solvingContinuous learning

Required

Bachelor's degree (lack of one should not stop you from applying if you possess all the other qualifications)

Minimum of 3 years of experience on point and concentrated in Personal Injury Protection

Have active adjuster license(s) and be willing to obtain all licenses within 45 days, including completing state required testing (must already have your home state license)

Knowledge of state regulations, policy provisions, and standard operating procedures

Ability to analyze and evaluate complex data and make sound decisions based on established guidelines, policies, and procedures

Curious and motivated by problem solving and questioning the status quo

Desire to engage in learning opportunities and continuous professional development

Willingness to travel for client and claims needs

Preferred

Handling the states of NY, NJ, MI, FL and/or KY

Handling of commercial, ride share or trucking policies is highly preferred

Understanding of how to handle subrogation referrals

Bodily Injury and coordination of benefits between PIP and UM / UIM

Arbitration and or formal PIP/MP litigation

Benefits

Generous health-insurance package with nationwide coverage, vision, & dental

401(k) retirement plan with employer matching

Competitive PTO policy – we want our employees fresh, healthy, happy, and energized!

Generous family leave policy

Work from anywhere to facilitate your work life balance

Apple laptop, large second monitor, and other quality-of-life equipment you may want. Technology is something that should make your life easier, not harder!