Sr. Claims Examiner - PIP and Auto Physical Damage

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This position will be primarily responsible for the direct handling of PIP claims and with some secondary responsibility for Auto Physical Damage Claims.

This role should be able to address all claim issues by gathering information necessary to make informed and responsible decisions to bring these PIP and APD claims to an appropriate resolution.

Key Accountabilities/Deliverables:


* Ensure compliance with established claim handling guidelines regarding coverage, investigation, liability, damages, evaluation, and resolution.


* Evaluating the nature and severity of PIP claims; reviewing medical bills, lost wages, and other expenses to determine if the insured is eligible for coverage based on policy terms, state regulations, and the specifics of each claim


* Negotiating by developing a PIP settlement strategy and negotiating with the claimant, their employer, and/or legal counsel.


* Keeping track of your PIP log to ensure proper medical payments are made per the coverage available


* Evaluate the extent of physical damages to determine coverage eligibility and accurately estimate repair costs based on industry standards and company guidelines.


* Establish reserves pursuant to established reserving protocols and reserve authority procedures.


* Investigate commercial claims, while following corporate standards and guidelines.


* Assist and review material damage estimates/appraisals to ensure accuracy and compliance with industry standards and procedures.


* Investigate commercial claims and communicate with policyholders, repair facilities and third-party claimants to reach fair and reasonable settlements.


* Review and negotiate material damage appraisals with mechanics, repair shops or similar vendors.


* In addition to the above key responsibilities, you may be required to undertake other duties from time to time as the Company may reasonably require.

Technical Knowledge and Understanding:


* Must be able to analyze Commercial Policy coverages, liability and damages


* Possess a comprehensive understanding and knowledge of state and federal laws (including legislation) applicable to PIP and Auto Physical Damage claims.


* Possesses an in-depth understanding of the policy language/coverage applicable to Commercial Auto Garage Business


* Possess knowledge of vehicle repair processes and procedures


* Computer skills – good working knowledge of MS Office, Excel


* Previously utilized an electronic claim system.

Experience:


* Insurance adjuster’s license required.


* College degree or equivalent work experience required.


* Minimum of 5 years’ experience handling PIP claims required


* Some PIP litigation handling preferred


* Minimum of 5 years’ experience handling physical damage/total loss claims preferred


* Ability to Travel


* Ability to negotiate and be persuasive.


* Must be detail-oriented to maintain accurate records ...