Commercial No Fault PIP/ Med Pay Adjuster - Claims Specialist II

Manages an inventory of claims. Establishes action plan based on case facts, best practices, protocols, regulatory issues and available resources. Plans and conduct investigations of claims to confirm coverage and eligibility to medically manage the claims through resolution. Assesses policy coverage for submitted claims and notifies the insured of any issues; determines and establishes reserve requirements, adjusting reserves, as necessary, during the processing of the claim, refers claims to the subrogation group or Special Investigations Unit as appropriate. Assesses actual damages associated with claims and conducts negotiations, within assigned authority limits, to settle claims. Performs other duties as assigned. BS/BA degree or equivalent work experience. Minimum of 2 years' experience in claims adjustment, general insurance or formal claims training. Required to obtain and maintain all applicable licenses. Continuing education courses leading to industry certifications preferred (e.g., AEI, IIA, CPCU). Knowledge of claims investigation techniques, medical terminology and legal aspects of claims.