STD Claims Examiner II making accurate claim decisions for Short Term Disability claims. Collaborating with team members in a hybrid work environment from South Portland, ME.
CI
Hybrid Senior Claims Examiner – PIP, Bodily Injury Claims Adjuster
Posted 4 months ago
About the role
- Claims Examiner responsible for direct handling of PIP claims and Auto Bodily Injury claims. Evaluating claims, negotiating settlements, and ensuring compliance with handling guidelines.
Responsibilities
- Primarily responsible for the direct handling of PIP claims with some secondary responsibility for light to moderate Auto Bodily Injury Claims
- Address all claim issues by gathering information necessary to make informed and responsible decisions
- Ensure compliance with established claim handling guidelines regarding coverage, investigation, liability, damages, evaluation, and resolution
- Evaluate the nature and severity of PIP claims, review medical bills, lost wages, and other expenses to determine coverage eligibility
- Negotiate by developing a PIP settlement strategy and negotiating with claimants, employers, and/or legal counsel
- Keep track of PIP log to ensure proper medical payments are made
- Utilize critical thinking and solid judgment to solve problems and resolve issues in handling PIP and Bodily Injury losses
- Draft declination, Reservation of Rights, and other coverage letters
- Establish reserves per reserving protocols and reserve authority procedures
- Investigate commercial claims and communicate with policyholders and third-party claimants for reasonable settlements
Requirements
- Insurance adjuster’s license required
- College degree or equivalent work experience required
- Minimum of 5 years’ experience handling PIP claims required
- PIP litigation handling preferred
- Experience handling Bodily Injury claims preferred
- Ability to travel occasionally
- Ability to negotiate and be persuasive
- Must be detail-oriented to maintain accurate records of payment transactions, settlement offers, etc.
- Possess effective oral and written communication skills
- Strong time-management skills, as some tasks will be time sensitive
- Applicants must be authorized to work for any employer in the U.S.
- We are unable to sponsor or take over sponsorship of an employment Visa for this position.
Benefits
- Medical, dental, vision, and life insurances
- Short and long-term disability
- Company-match of 100% of a 6% contribution 401(k) plan
- Employee Assistance Plan
- Health Savings Account
- Flexible Spending Account
- Health Reimbursement Account
- Wellness program
Job title
Job type
Experience level
Salary
Not specified
Degree requirement
Location requirements
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