Executive Claims Specialist, PIP, Remote

Crum & Forster

$64K — $121K *
US-AnywhereRemote in Morristown, NJ
Finance & Insurance
5 - 7 years of experience
Job Overview by Ladders

Qualifications

  • 6-10 years of PIP/no-fault claims experience inclusive of complex matters.
  • Hands-on experience in New Jersey, New York, and/or Pennsylvania no-fault jurisdictions is preferred.
  • Comprehensive knowledge of medical management, treatment disputes, and regulatory compliance.
  • Significant experience in PIP litigation and arbitration processes.
  • Experience with third-party administrator oversight or similar program management is preferred.
  • Strong analytical, written, and verbal communication skills are essential.
  • A Bachelor's degree is required; relevant designations like CPCU or law degrees are a plus.

Responsibilities

  • Provide senior-level technical oversight of PIP claims handled by Third-Party Administrators.
  • Act as a subject matter expert on PIP coverage and disputes.
  • Offer technical guidance on complex claims involving litigation and arbitration.
  • Evaluate eligibility and coverage priority to assess risk-transfer options.
  • Review claims for accuracy and ensure compliance with laws and regulations.
  • Collaborate with TPA professionals to improve claim handling processes.
  • Conduct audits and quality reviews of claims handling.

Benefits

  • Competitive compensation package.
  • Generous 401K employer match.
  • Employee Stock Purchase plan with employer matching.
  • Generous Paid Time Off policy.
  • Comprehensive benefits program focusing on overall wellness.
  • Opportunities for career development with tuition reimbursement and professional training.
  • Supportive work environment promoting social responsibility and community engagement.
Full Job Description

S&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

 

 

At C&F you will BELONG

 

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