Commercial No Fault PIP/ Med Pay Adjuster - Claims Specialist II

Claims Specialist

At Liberty, you'll thrive in a hybrid setting that fosters in-person collaboration, innovation and growth. This approach optimizes both remote and in-person interactions, enabling you to connect and ideate with your team and deepen valuable relationships across the company, while still enjoying the flexibility of remote work for focused tasks and projects.

The Claims Specialist analyzes complex Personal Injury Protection (PIP) and Medical Payment (Med-Pay) No Fault claims, determines benefits owed, manages and adjudicates high-exposure claims to meet service standards and client requirements. The Claims Specialist works within a Claims Team, using the latest technology to manage an assigned caseload of routine to moderately complex claims from the investigation of the claim through resolution. This includes making decisions about coverage and eligibility, evaluating losses, medically managing claims, paying medical bills, and negotiating settlements. The role interacts with claimants, policyholders, providers, attorneys, and other third parties throughout the claim's management process. The position offers training developed with an emphasis on enhancing skills needed to help provide exceptional service to our customers.

You will be required to go into the office twice a month if you reside within 50 miles of one of the following offices: Westborough, MA; Boston, MA; Weatogue, CT; Indianapolis, IN; Hoffman Estates, IL; Lake Oswego, OR; Chandler, AZ; Las Vegas, NV; Plano, TX; or Suwanee, GA. Please note this policy is subject to change.

Responsibilities:

• Manages an inventory of claims.
• Establishes action plan based on case facts, best practices, protocols, regulatory issues and available resources.
• Plans and conduct investigations of claims to confirm coverage and eligibility to medically manage the claims through resolution.
• Assesses policy coverage for submitted claims and notifies the insured of any issues; determines and establishes reserve requirements, adjusting reserves, as necessary, during the processing of the claim, refers claims to the subrogation group or Special Investigations Unit as appropriate.
• Assesses actual damages associated with claims and conducts negotiations, within assigned authority limits, to settle claims.
• Performs other duties as assigned.

Qualifications:

• BS/BA degree or equivalent work experience.
• Minimum of 2 years' experience in claims adjustment, general insurance or formal claims training.
• Required to obtain and maintain all applicable licenses.
• Continuing education courses leading to industry certifications preferred (e.g., AEI, IIA, CPCU).
• Knowledge of claims investigation techniques, medical terminology and legal aspects of claims.

About Us:

Pay Philosophy: The typical starting salary range for this role is determined by a number of factors including skills, experience, education, certifications and location. The full salary range for this role reflects the competitive labor market value for all employees in these positions across the national market and provides an opportunity to progress as employees grow and develop within the role. Some roles at Liberty Mutual have a corresponding compensation plan which may include commission and/or bonus earnings at rates that vary based on multiple factors set forth in the compensation plan for the role.

At Liberty Mutual, our goal is to create a workplace where everyone feels valued, supported, and can thrive. We build an environment that welcomes a wide range of perspectives and experiences, with inclusion embedded in every aspect of our culture and reflected in everyday interactions. This comes to life through comprehensive benefits, workplace flexibility, professional development opportunities, and a host of opportunities provided through our Employee Resource Groups. Each employee plays a role in creating our inclusive culture, which supports every individual to do their best work. Together, we cultivate a community where everyone can make a meaningful impact for our business, our customers, and the communities we serve. We value your hard work, integrity and commitment to make things better, and we put people first by offering you benefits that support your life and well-being.

• California
• Los Angeles Incorporated
• Los Angeles Unincorporated
• Philadelphia
• San Francisco