Executive Claims Specialist, PIP

🔥 12 hours ago

🏖️ New Jersey – Remote

🏖️ New Jersey – Remote

💵 $64.7k - $121.6k / year

⏰ Full Time

🟡 Mid-level

🟠 Senior

📋 Claims Specialist

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Crum & Forster

WebsiteLinkedInAll Job Openings

1001 - 5000 employees

🛡️ Insurance

⚕️ Healthcare Insurance

Insurance • Healthcare Insurance

Crum & Forster (C&F) is a leading national property & casualty insurance company with a large, diversified specialty platform. Established in 1822, C&F provides specialty and standard commercial lines insurance products through its admitted and surplus lines insurance companies. With a written premium of $5. 3 billion as of 2023, C&F has an A. M. Best financial strength rating of “A” (Excellent). The company prides itself on creative, flexible, and client-focused solutions, recognized for superior customer service, claims, and risk engineering services. C&F employs over 2000 people across the United States and has earned several workplace awards for its employee-first focus and commitment to diversity, equity, and inclusion. C&F is part of Fairfax Financial Holdings Limited, engaged in property and casualty insurance and reinsurance.

📋 Description

• 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 statutory and regulatory compliance • Partner with TPA claim professionals and leadership to address concerns and improve claim handling • 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 partners • Support enhancements to claim guidelines, workflows, reporting, training and quality controls • Maintain awareness of legislative, regulatory and judicial developments affecting PIP/no-fault claims

🎯 Requirements

• 6+ years of progressively responsible PIP/no-fault claims experience; 8–10 preferred • 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

🏖️ Benefits

• Competitive compensation package • Generous 401K employer match • Employee Stock Purchase plan with employer matching • Generous Paid Time Off • Health, dental and vision benefits • Wellness programs focused on physical, mental and financial wellbeing • Tuition reimbursement • Industry-related certifications • Professional training • Dynamic, ambitious, fun and exciting work environment • Matching donation program • Volunteer opportunities • Employee-driven corporate giving program • Special accommodations and inclusive workplace support