Claims Specialist II, First Party Medical

This is a fully remote position, open to applicants in Alabama, +36 more states.

📋 Description

• Investigate and address both non-litigated and litigated First Party PIP and MedPay claims of various complexities.

• Administer non-medical benefits, including lost wages, funeral benefits, and additional compensations.

• Engage with insured individuals, attorneys, medical providers, and other pertinent parties to finalize investigations.

• Keep all relevant parties updated regarding the status of claims.

• Operate within the claims system and collaborate with preferred partners to ensure high-quality documentation.

• Assess the necessity for medical management when suitable.

• Process submitted bills in compliance with statutory requirements.

• Recognize potential fraud indicators and collaborate with SIU as needed.

• Resolve claims in accordance with state regulations and company policies.

• Be available to work non-traditional hours as required.

• Execute other assigned duties as necessary.

• Offer Branch members clear expectations and support throughout the claims process.

⛳️ Requirements

• A minimum of 3 years of progressive, front-line experience in multi-state PIP and MedPay claims handling.

• At least 1 year of experience in litigated claims resolution, including overseeing outside panel counsel, is preferred.

• Strongly preferred: Adjuster license(s) and experience in multi-state claims handling, particularly in MI, NY, NJ, and FL.

• Familiarity with venue-specific No-Fault laws and regulations, including MCCA.

• Proficient in bill adjudication.

• Excellent interpersonal skills.

• Capability to communicate effectively across all organizational levels.

• Willingness to work non-traditional hours.

• A member-focused mindset and a commitment to exceed expectations.

• Innovative, outside-the-box problem-solving skills.

• Ability to make informed decisions with incomplete information.

• Preferred experience in remote work settings.

• Must currently have authorization to work full-time in the United States.

• The employer does not sponsor or take over sponsorship of employment visas.

🏝️ Benefits

• Competitive salary above market rates.

• Commitment to pay equity and transparency.

• Remote-first work environment.

• Work-from-home setup provided.

• Monthly internet coverage.

• Flexible YouTime/time off policy.

• $1,000 vacation contribution after the first year of employment.

• Employee stock options available for full-time staff.

• Comprehensive medical insurance.

• Vision insurance coverage.

• Dental insurance options.

• 401(k) contribution matching program.

• Annual gathering for BranchFest company event.