Claims Specialist

Job Summary The Claims Specialist is responsible for the end‑to‑end handling of Personal Injury Protection (PIP) and Medical Payment (Med Pay) claims across numerous jurisdictions, from initial investigation through resolution. This role focuses on accurate coverage determination, compliance with state and federal regulations, and fair and timely claim outcomes. The Specialist manages moderate to high‑complexity PIP and Med Pay claims and collaborates closely with internal partners, medical providers, vendors, and defense counsel as needed. This is a 100% in‑office position; candidates must work on‑site during standard business hours. Essential Responsibilities Investigate, evaluate, negotiate, and resolve PIP and Med Pay claims in compliance with state statutes, regulations, and case law Handle PIP arbitrations as necessary Confirm coverage, review facts of loss, assess injuries, treatment, and medical necessity Review and process medical bills, applying fee schedules, coding standards, and cost‑containment methodologies Evaluate claim complexity and exposure; escalate or refer matters appropriately Communicate directly with claimants, attorneys, medical providers, and vendors Negotiate settlements and ensure proper documentation, releases, and regulatory timeframes Identify and address coverage, liability, or fraud indicators when present Maintain accurate claim documentation and meet regulatory and internal service standards Qualifications / Experience Required 4 years of claims experience Experience evaluating medical records, treatment plans, and claim disputes Active adjuster license and ability to maintain required continuing education Strong negotiation, analytical, and written communication skills Preferred Qualifications Bachelor’s degree in a related field or equivalent work experience Salary Range $52,122 - $82,926 Other Requirements Applicants must be legally authorized to work in the United States. At this time, we are not able to sponsor or assume sponsorship of employment visas. If you have a disability under the Americans with Disabilities Act or similar state or local law and wish to discuss reasonable accommodations, please contact our Benefits Department. Equal Opportunity Employer We are an Equal Opportunity Employer. We do not discriminate on the basis of age, ancestry, color, gender, gender expression, gender identity, genetic information, marital status, national origin or citizenship (including language use restrictions), denial of family and medical care leave, disability (mental and physical), including HIV and AIDS, medical condition (including cancer and genetic characteristics), race, religious creed (including religious dress and grooming practices), sex (including pregnancy, childbirth, breastfeeding, and medical conditions related to pregnancy, childbirth or breastfeeding), sexual orientation, military or veteran status, or other status protected by laws or regulations in the locations where we operate. We do not tolerate discrimination or harassment based on any of these characteristics. Benefits We offer a competitive compensation package, performance‑based incentives, and a comprehensive benefits program that includes health, dental, vision, a 401(k) with company match, paid time off, and professional development opportunities. #J-18808-Ljbffr