What are the responsibilities and job description for the PIP Claims Adjuster position at N&D?
Key Responsibilities:
- Conduct thorough investigations of PIP claims, including review of medical records, accident reports, and other relevant documentation.
- Evaluate medical necessity and reasonableness of treatments and expenses in compliance with state laws and policy coverage.
- Establish and maintain appropriate reserves for claims.
- Monitor claim progress, manage documentation, and ensure accurate and timely updates in claims management systems.
- Communicate effectively with policyholders, claimants, attorneys, and medical providers to gather information and explain the claims process.
- Provide compassionate and professional support throughout the claims lifecycle.
- Ensure compliance with applicable PIP laws, regulations, and company guidelines.
- Prepare detailed claim summaries, reports, and settlement recommendations for management review as needed.
- Evaluate and negotiate settlements within authority levels to achieve equitable outcomes.
- Collaborate with legal and medical professionals to resolve disputed claims.
- Identify and address potential fraud indicators and escalate cases for Special Investigation Unit (SIU) review when necessary.
- Stay informed of industry trends, legislative changes, and best practices related to PIP claims.
- Participate in training and development opportunities to enhance technical knowledge and customer service skills.
Qualifications:
- Education: High school diploma or equivalent required; bachelor’s degree in business, insurance, or a related field preferred.
- Strong interpersonal skills and ability to collaborate with cross-functional teams.
- Ability to manage multiple priorities and work independently.
- Ability to manage multiple tasks and deadlines effectively.
- Strong analytical and problem-solving abilities.
- Familiarity with state-specific PIP statutes and no-fault insurance laws is a plus.
- Proficiency with claims management systems and office software (e.g., MS Office).
This role is crucial for enhancing the efficiency and effectiveness of the claims department and supporting the organization’s claims handling activities. It offers an excellent opportunity for professionals with a keen interest in the insurance industry.
We offer a competitive total compensation package including medical, dental, vision & life insurance, pension and a 401(k) with match.
The N&D® Group has adopted a hybrid work model with employees working 3 days in the office and 2 days remote.
Our office headquarters is located in Dedham, MA at a brand-new state of the art facility, recently completed in June 2022. Our employees enjoy the use of a complimentary on-site café, fitness center and free parking.
The Norfolk & Dedham Group® is an Equal Opportunity Employer
