Personal Injury Protection (PIP) Adjuster

Description 

About Reserv 

Reserv is an insurtech creating and incubating cutting-edge AI and automation technology to bring efficiency and simplicity to claims. Founded by insurtech veterans with deep experience in SaaS and digital claims, Reserv is venture-backed by Bain Capital and Altai Ventures and began operations in May 2022. We are focused on automating highly manual tasks to tackle long-standing problems in claims and set a new standard for TPAs, insurance technology providers, and adjusters alike. 

We have ambitious (but attainable!) goals and need adjusters who can work in an evolving environment. If building a leading TPA and the prospect of tackling the long-standing challenges of the claims role sounds exciting, we can’t wait to meet you.  

 

About the role 

We are seeking a detail-oriented Personal Injury Protection Resolution Specialist to join our team. The PIP Resolution Specialist will be responsible for investigating and evaluating PIP / MP claims and coverage. The ideal candidate will have strong analytical skills, excellent communication abilities, and a commitment to providing exceptional customer service. Your role will also be responsible for handling an inventory of PIP claims and delivering service to all constituents of the claim. 

The ideal candidate has a willingness to work through and design process that supports the quickest claim resolution with the best outcome. In addition, you will collaborate closely with our product and engineering teams to give feedback and identify technology and process improvements.  

Who you are 

• Highly motivated and growth-oriented. You're excited by the prospect of building a tech-driven claims org. 
• Passionate claim professional who cares about the customer and their experience. 
• Empathetic. You exercise empathy and patience towards everyone you interact with.  
• Sense of urgency - at all times. That does not mean working at all hours. 
• Creative. You can find the right exit ramp (pun intended) for the resolution of the claim that is in the insured’s best interest.  
• Conflict-enjoyer. Conflict does not have to be adversarial, but it HAS to be conversational.  
• Curious. You have to want to know the whole story so you can make the right decisions early and action them to a prompt resolution.  
• Anti-status quo. You don’t just wish things were done differently, you action on it.  
• Communicative. (we'd love to know what this means to you) 
• And did we mention, you have a sense of humor. Claims are hard enough as it is.  

What we need 

We need you to do all the things typical to the role: 

• Provide prompt, courteous and high-quality customer service to all policyholders and claimants by answering customer calls, filing claims, and resolving customer requests 
• Investigate PIP / MP claims to determine coverage, extent of injury and evaluate medical billing for necessity and relatedness to the claim.
• Gather relevant documentation, interview involved parties, explain policy, coverage, and appropriate course of action and resolve related medical expenses. 
• Assess the validity of PIP claims based on collected evidence, medical records, and applicable laws. Determine the appropriate settlement amount if appropriate, ongoing plan for resolution and recommend further action if necessary.  
• Manage an inventory of claims, establish initial reserves for all potential exposures, and adjust as appropriate throughout the claim 
• Ensure compliance with specific state regulations, policy provisions, and standard operating procedures 
• Maintain regular communication with claimants, policyholders, attorneys, medical providers, and other relevant parties to provide updates on claim status, request additional information, and facilitate the claims process within approved payment authority 
• Prepare thorough and accurate claim reports, including detailed summaries of investigation findings, evaluation of damages, and rationale for claim decisions. 
• Provide input for continuous development of claims guidelines, best practices, and process improvements 
• Oversee and direct outside investigative service providers and work closely with the client and client counsel and investigative services to resolve the claim 
• Engage in learning opportunities to build knowledge of commercial lines claims, court decisions impacting the claims function, current guidelines in claims function, and policy changes and modifications 

Requirements 

• Bachelor's degree (lack of one should not stop you from applying if you possess all the other qualifications) 
• Minimum of 3