Claims Specialist

Company

Farm Family specializes in farm and ranch protection with a wide range of products including flexible farm packages, business owner policies, commercial package, workers compensation, commercial auto and select personal auto coverage. Farm Family is a leader in serving the Northeast and Mid-Atlantic markets and is pursuing growth across the U.S. The Farm Family entities are wholly-owned subsidiaries of Clearbrook Group Holdings Inc.

Job Description

Summary:

The Claims Specialist is responsible for the endtoend handling of Personal Injury Protection (PIP) and Medical Payment (Med Pay) claims across numerous jurisdictions, from initial investigation through resolution. Working with a high degree of autonomy, this role focuses on accurate coverage determination, compliance with state and federal regulations, as well as fair and timely claim outcomes.

The Specialist manages moderate to highcomplexity 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 be able to work on-site at a designated company office 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, and assess injuries, treatment and medical necessity

• Review and process medical bills, applying fee schedules, coding standards, and costcontainment 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'sdegree in a related field or the equivalent work experience

  Salary range is $52122 - $82926

PLEASE NOTE:

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 you wish to discuss potential reasonable accommodations related to applying for employment with us, please contact our Benefits Department at View phone number on click.appcast.io.

Notice to Recruitment Agencies:
Resumes submitted for this or any other position without prior authorization from Human Resources will be considered unsolicited. BWS and / or its affiliates will not be responsible for any fees associated with unsolicited submissions.

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, child birth, breastfeeding, and medical conditions related to pregnancy, child birth 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.

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Benefits and Compensation

We offer a competitive compensation package, performance-based incentives, and a comprehensive benefits program-including health, dental, vision, 401(k) with company match, paid time off, and professional development opportunities.