Executive Claims Specialist, PIP

This is a fully remote position, open to applicants in New Jersey.

📋 Description

• Oversee technical aspects of PIP/no-fault claims managed by Third-Party Administrators at a senior level.

• Act as a subject matter expert for PIP, covering areas such as benefits, treatment disputes, medical necessities, peer reviews, IMEs, denials, and regulatory requirements.

• Offer technical direction on intricate, disputed, litigated, and arbitrated PIP cases.

• Assess coverage, benefit eligibility, coverage priorities, and potential risk-transfer options.

• Review claims handling to ensure accuracy, timeliness, documentation, and compliance with statutory and regulatory standards.

• Collaborate with TPA claim professionals and leadership to resolve issues and enhance claim handling processes.

• Perform targeted claim audits and quality assessments.

• Analyze reserve adequacy and provide technical recommendations for complex exposures.

• Identify trends related to providers, litigation, claims handling, leakage, compliance, and emerging risks.

• Coordinate efforts with Legal, SIU, medical review vendors, defense attorneys, and other stakeholders.

• Support the improvement of claims guidelines, workflows, reporting, training, and quality control measures.

• Stay informed about legislative, regulatory, and judicial changes impacting PIP/no-fault claims.

⛳️ Requirements

• Minimum of 6 years of progressively responsible experience in PIP/no-fault claims; 8 to 10 years preferred.

• Strong preference for extensive hands-on experience with New Jersey, New York, and/or Pennsylvania no-fault claims.

• In-depth knowledge of medical management, coverage, treatment disputes, benefit denials, and regulatory compliance.

• Significant experience in PIP litigation and arbitration.

• Preferred experience with TPA oversight, carrier technical claims, quality assurance, or similar program management.

• Experience in commercial auto claims is desirable.

• Familiarity with rideshare, transportation network companies, or the sharing economy is a plus but not mandatory.

• Excellent analytical, written, and verbal communication skills.

• A Bachelor’s degree is required.

• Professional designations such as CPCU, AIC, SCLA, law degree, or other relevant credentials are advantageous.

• Occasional travel may be necessary.

🏝️ Benefits

• Attractive compensation package.

• Generous employer matching for 401K contributions.

• Employee Stock Purchase plan with company matching.

• Ample Paid Time Off.

• Comprehensive health, dental, and vision insurance.

• Wellness initiatives aimed at promoting physical, mental, and financial health.

• Tuition reimbursement for further education.

• Support for industry-related certifications.

• Professional development training opportunities.

• An engaging, ambitious, and enjoyable work environment.

• Matching donation programs.

• Opportunities for volunteering.

• Employee-driven corporate giving initiatives.

• Special accommodations and support for an inclusive workplace.