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Executive Claims Specialist, PIP, Remote

$64.7k

Crum & Forster

Job DescriptionS&S Transportation & Sharing Economy is seeking an experienced Executive Claims Specialist – Personal Injury Protection / No-Fault to provide senior-level technical oversight of Personal Injury Protection (PIP) claims within our sharing economy program. This position will primarily support multiple states with New Jersey, New York and Pennsylvania no-fault experience strongly preferred. The ideal candidate is a seasoned PIP professional with strong technical judgment, litigation and arbitration experience, and the ability to partner effectively with Third-Party Administrators and other stakeholders to promote quality claim outcomes. This is an oversight and technical leadership role rather than a traditional claim-production position.What you will do for C&F:Provide senior-level technical oversight of PIP/no-fault claims administered by Third-Party Administrators.Serve as a subject matter resource for PIP, including coverage, medical benefits, treatment disputes, medical necessities, peer reviews, IMEs, denials and regulatory requirements.Provide technical guidance on complex, disputed, litigated and arbitrated PIP matters.Evaluate coverage, benefit eligibility, priority of coverage and potential risk-transfer opportunities.Review claim handling for accuracy, timeliness, documentation and compliance with applicable statutory and regulatory requirements.Partner with TPA claim professionals and leadership to address claim handling concerns, reinforce program expectations and identify opportunities for improvement.Conduct targeted claim audits and quality reviews.Evaluate reserve adequacy and provide technical recommendations on complex exposures.Identify trends involving providers, litigation, claim handling, leakage, compliance and emerging exposures.Coordinate with Legal, SIU, medical review vendors, defense counsel and other internal and external partners as appropriate.Support enhancements to claim guidelines, workflows, reporting, training and quality controls.Maintain awareness of legislative, regulatory and judicial developments affecting PIP/no-fault claims.What you will bring to C&F:6+ years (8-10 preferred) of progressively responsible PIP/no-fault claims experience, including complex or technically advanced matters.Extensive hands-on New Jersey, New York and/or Pennsylvania no-fault experience strongly preferred.Strong knowledge of medical management, coverage, treatment disputes, benefit denials and regulatory compliance.Significant PIP litigation and arbitration experience.Experience with TPA oversight, carrier technical claims, quality assurance or similar program oversight preferred.Commercial auto experience. Rideshare, transportation network company or sharing economy experience is a plus but not required.Strong analytical, written and verbal communication skills.Bachelor's degree required. CPCU, AIC, SCLA, law degree or other relevant professional designation is a plus.Occasional travel may be required.What C&F will bring to youCompetitive compensation packageGenerous 401K employer matchEmployee Stock Purchase plan with employer matchingGenerous Paid Time OffExcellent benefits that go beyond health, dental & vision. Our programs are focused on your whole family's wellness, including your physical, mental and financial wellbeingA core C&F tenet is owning your career development, so we provide a wealth of ways for you to keep learning, including tuition reimbursement, industry-related certifications and professional training to keep you progressing on your chosen pathA dynamic, ambitious, fun and exciting work environmentWe believe you do well by doing good and want to encourage a spirit of social and community responsibility, matching donation program, volunteer opportunities, and an employee-driven corporate giving program that lets you participate and support your communityAt C&F you will BELONGIf you require special accommodations, please let us know. We value inclusivity and diversity. We are committed to equal employment opportunity and welcome everyone regardless of race, color, ancestry, religion, sex, national origin, sexual orientation, age, citizenship, marital status, disability, gender identity, or Veteran status. If you require special accommodations, please let us knowFor California Residents Only: Information collected and processed as part of your career profile and any job applications you choose to submit are subject to our privacy notices and policies, visit for more information.Crum & Forster is committed to ensuring a workplace free from discriminatory pay disparities and complying with applicable pay equity laws. Salary ranges are available for all positions at this location, taking into account roles with a comparable level of responsibility and impact in the relevant labor market and these salary ranges are regularly reviewed and adjusted in accordance with prevailing market conditions. The annualized base pay for the advertised position, located in the specified area, ranges from a minimum of $64,700.00 to a maximum of $121,600.00. The actual compensation is determined by various factors, including but not limited to the market pay for the jobs at each level, the responsibilities and skills required for each job, and the employee's contribution (performance) in that role. To be considered within market range, a salary is at or above the minimum of the range. You may also have the opportunity to participate in discretionary equity (stock) based compensation and/or performance-based variable pay programs. Crum & Forster

Vacancy posted 4 days ago
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