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PIP Claims Resolution Expert
2 months ago
Position Summary
About Reserv
Reserv is an innovative insurtech company dedicated to developing advanced AI and automation solutions aimed at enhancing efficiency and simplicity in the claims process. With a foundation built by industry veterans experienced in SaaS and digital claims, we are backed by prominent investors and have been operational since May 2022. Our mission is to automate labor-intensive tasks to address persistent challenges in claims management and to set a new benchmark for third-party administrators, insurance technology providers, and adjusters.
We are on the lookout for skilled adjusters who thrive in a dynamic environment and are eager to contribute to the evolution of claims processing. If you are excited about the opportunity to redefine the claims landscape, we would like to connect with you.
Role Responsibilities
We are in search of a meticulous Personal Injury Protection Resolution Specialist. This role involves investigating and assessing PIP and MP claims as well as coverage determinations. The ideal candidate will possess strong analytical capabilities, outstanding communication skills, and a dedication to delivering exceptional customer service. Your responsibilities will include managing a portfolio of PIP claims and ensuring effective service delivery to all stakeholders involved.
The perfect candidate will demonstrate a proactive approach to developing processes that facilitate swift claim resolutions with optimal outcomes. Additionally, you will work closely with our product and engineering teams to provide insights and identify opportunities for technological and procedural enhancements.
Candidate Profile
- Driven and growth-oriented, with a passion for building a technology-focused claims organization.
- Committed claims professional who prioritizes customer experience.
- Empathetic, demonstrating patience and understanding in all interactions.
- Possesses a strong sense of urgency, balanced with respect for work-life boundaries.
- Creative thinker, capable of finding innovative solutions that serve the best interests of the insured.
- Enjoys engaging in constructive conversations, even in conflict situations.
- Inquisitive, eager to uncover the full context to make informed decisions promptly.
- Proactive in challenging the status quo and implementing changes.
- Effective communicator, with a personal interpretation of what that entails.
- Brings a sense of humor to the challenging nature of claims work.
Key Responsibilities
As a PIP Resolution Specialist, you will:
- Deliver prompt, courteous, and high-quality service to policyholders and claimants through effective communication and resolution of inquiries.
- Conduct thorough investigations of PIP and 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 resolve related medical expenses.
- Evaluate the legitimacy of PIP claims based on gathered evidence, medical records, and applicable regulations, determining appropriate settlement amounts and recommending further actions as needed.
- Manage a portfolio of claims, setting initial reserves for potential exposures and adjusting as necessary throughout the claims process.
- Ensure adherence to state regulations, policy provisions, and established operational procedures.
- Maintain regular communication with claimants, policyholders, attorneys, medical providers, and other relevant parties to provide updates and facilitate the claims process.
- Prepare comprehensive and accurate claims reports, detailing investigation findings, damage evaluations, and rationale for decisions.
- Contribute to the ongoing development of claims guidelines, best practices, and process improvements.
- Oversee and coordinate with external investigative service providers and collaborate with clients and their legal representatives to resolve claims.
- Engage in professional development opportunities to enhance knowledge of commercial lines claims, relevant court decisions, and policy changes.
Qualifications
- Bachelor's degree preferred, though not mandatory if other qualifications are met.
- A minimum of 3 years of specialized experience in Personal Injury Protection, with a focus on:
- Handling claims in states such as NY, NJ, MI, FL, and/or KY.
- Managing subrogation referrals.
- Coordinating benefits between PIP and UM/UIM.
- Experience with arbitration and formal PIP/MP litigation.
- Possession of active adjuster licenses, with a willingness to obtain additional licenses as required.
- Knowledge of state regulations, policy provisions, and standard operating procedures.
- Strong analytical skills to evaluate complex data and make informed decisions.
- A commitment to continuous learning and professional growth.
- Willingness to travel as necessary for client and claims needs.
Benefits
- Comprehensive health insurance package, including vision and dental coverage.
- 401(k) retirement plan with employer matching contributions.
- Generous paid time off policy to support employee well-being.
- Family leave policy that prioritizes work-life balance.
- Flexible remote work options complemented by regular corporate retreats to foster team cohesion and culture.
- Provision of high-quality technology, including an Apple laptop and additional equipment to enhance productivity.
Our Commitment
At Reserv, we celebrate diversity and believe that a variety of perspectives drives innovation and success. We actively seek candidates who can bring unique experiences and viewpoints to our team. If you align with our values and believe you are a suitable candidate for this role, we look forward to your application.
