Job DescriptionS&S Transportation & Sharing Economy is seeking an experienced
Executive Claims Specialist - Personal Injury Protection / No-Fault to provide senior-level technical oversight of Personal Injury Protection (PIP) claims within our sharing economy program. This position will primarily support multiple states with
New Jersey,
New York and
Pennsylvania no-fault experience strongly preferred. The ideal candidate is a seasoned PIP professional with strong technical judgment, litigation and arbitration experience, and the ability to partner effectively with Third-Party Administrators and other stakeholders to promote quality claim outcomes. This is an
oversight and technical leadership role rather than a traditional claim-production position.
What you will do for C&F:- 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 compliance with applicable statutory and regulatory requirements.
- Partner with TPA claim professionals and leadership to address claim handling concerns, reinforce program expectations and identify opportunities for improvement.
- 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 internal and external partners as appropriate.
- Support enhancements to claim guidelines, workflows, reporting, training and quality controls.
- Maintain awareness of legislative, regulatory and judicial developments affecting PIP/no-fault claims.
What you will bring to C&F:
- 6+ years (8-10 preferred) of progressively responsible PIP/no-fault claims experience, including complex or technically advanced matters.
- 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.
What C&F will bring to you- Competitive compensation package
- Generous 401K employer match
- Employee Stock Purchase plan with employer matching
- Generous Paid Time Off
- Excellent benefits that go beyond health, dental & vision. Our programs are focused on your whole family's wellness, including your physical, mental and financial wellbeing
- A core C&F tenet is owning your career development, so we provide a wealth of ways for you to keep learning, including tuition reimbursement, industry-related certifications and professional training to keep you progressing on your chosen path
- A dynamic, ambitious, fun and exciting work environment
- We believe you do well by doing good and want to encourage a spirit of social and community responsibility, matching donation program, volunteer opportunities, and an employee-driven corporate giving program that lets you participate and support your community
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