PIP Claims Resolution Specialist

2 weeks ago

Atlanta, Georgia, United States Reserv Full time
Job Overview

Position Summary

About Reserv

Reserv is an innovative insurtech company focused on developing advanced AI and automation solutions to enhance efficiency and streamline the claims process. Established by industry experts with extensive backgrounds in SaaS and digital claims, we are supported by prominent investors and have been operational since May 2022. Our mission is to automate traditionally manual tasks, addressing persistent challenges in claims management and setting a new benchmark for TPAs, insurance technology providers, and adjusters.

We are driven by ambitious yet achievable goals and are in search of adjusters who thrive in a dynamic environment. If you are excited about the opportunity to help build a leading TPA and tackle the enduring challenges of the claims profession, we look forward to connecting with you.

Role Responsibilities

We are looking for a meticulous Personal Injury Protection Resolution Specialist. The individual in this role will be tasked with investigating and assessing PIP/MP claims and coverage. The ideal candidate will possess strong analytical capabilities, excellent communication skills, and a dedication to delivering outstanding customer service. Responsibilities will include managing a portfolio of PIP claims and ensuring effective service delivery to all stakeholders involved.

The successful candidate will be eager to develop and implement processes that facilitate the swift resolution of claims while achieving optimal outcomes. Additionally, collaboration with our product and engineering teams will be essential to provide insights and identify areas for technological and procedural enhancements.

Candidate Profile

  • Highly driven and focused on growth, with a passion for building a technology-oriented claims organization.
  • Dedicated claims professional who prioritizes customer experience.
  • Empathetic, demonstrating patience and understanding in all interactions.
  • Possesses a strong sense of urgency without compromising work-life balance.
  • Creative thinker, able to devise innovative solutions that prioritize the insured's best interests.
  • Enjoys engaging in constructive dialogue to resolve conflicts.
  • Curious and eager to uncover the full context of claims to make informed decisions promptly.
  • Proactive in challenging the status quo and implementing improvements.
  • Effective communicator, with a unique interpretation of what communication means.
  • Brings a sense of humor to the workplace, recognizing the challenges of claims management.

Key Responsibilities

The role encompasses the following typical duties:

  • Deliver prompt, courteous, and high-quality customer service to policyholders and claimants through effective communication and resolution of inquiries.
  • Conduct thorough investigations of PIP/MP claims to ascertain coverage, evaluate injuries, and assess medical billing for relevance and necessity.
  • Collect pertinent documentation, interview involved parties, clarify policy details, and address related medical expenses.
  • Evaluate the legitimacy of PIP claims based on gathered evidence, medical records, and applicable regulations, determining appropriate settlement amounts and ongoing resolution strategies.
  • Manage a portfolio of claims, establishing initial reserves for potential exposures and adjusting as necessary throughout the claims process.
  • Ensure adherence to state regulations, policy provisions, and standard operating procedures.
  • Maintain consistent communication with claimants, policyholders, attorneys, medical providers, and other relevant parties to provide updates and facilitate the claims process.
  • Prepare comprehensive and accurate claim reports, detailing investigation findings, damage evaluations, and rationale for decisions made.
  • Contribute to the ongoing development of claims guidelines, best practices, and process enhancements.
  • Oversee and coordinate with external investigative service providers, collaborating closely with clients and their legal representatives to resolve claims.
  • Engage in continuous learning opportunities to expand knowledge of commercial lines claims, relevant court decisions, and current industry guidelines.

Qualifications

  • Bachelor's degree preferred; however, candidates lacking a degree but possessing relevant experience are encouraged to apply.
  • A minimum of 3 years of focused experience in Personal Injury Protection, ideally with exposure to:
    • Handling claims in states such as NY, NJ, MI, FL, and/or KY.
    • Subrogation referrals.
    • Bodily Injury and coordination of benefits between PIP and UM/UIM.
    • Arbitration and formal PIP/MP litigation.
  • Possession of active adjuster licenses, with a willingness to obtain any additional required licenses promptly.
  • In-depth knowledge of state regulations, policy provisions, and standard operating procedures.
  • Ability to analyze complex data and make informed decisions based on established guidelines.
  • A strong desire for problem-solving and challenging conventional practices.
  • Commitment to ongoing professional development and learning.
  • Willingness to travel as needed for client and claims-related activities.

Employee Benefits

  • Comprehensive health insurance package with nationwide coverage, including vision and dental.
  • 401(k) retirement plan with employer matching contributions.
  • Competitive paid time off policy to ensure employee well-being and work-life balance.
  • Generous family leave policy.
  • Flexible work-from-anywhere policy to support work-life balance, complemented by regular corporate retreats to foster team cohesion and culture.
  • Provision of an Apple laptop, large second monitor, and other necessary equipment to enhance productivity.

Our Commitment

  • We strive to provide a manageable workload that allows for effective service delivery.
  • We value employee feedback to address and improve upon the longstanding challenges faced by adjusters.
  • We aim to minimize administrative burdens associated with the adjuster role.
  • We foster a culture of empathy, transparency, and empowerment in a remote-first work environment.

At Reserv, we embrace diversity and believe that varied perspectives drive innovation and success. We actively seek candidates who can contribute unique viewpoints and experiences to our team and welcome applicants from all backgrounds.

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