PIP Claims Handler

This is a remote position.

Position Summary:

We are seeking an experienced PIP Claims Handler to manage and investigate Personal Injury Protection (PIP) claims related to automotive accidents. This role is heavily focused on reviewing claims for accuracy, identifying inconsistencies, mitigating fraud exposure, and controlling claim costs while ensuring compliance with state regulations and policy requirements.

The ideal candidate has extensive experience handling PIP claims within the auto insurance, legal, healthcare billing, or claims administration space and is highly skilled at scrutinizing medical documentation, billing practices, and treatment timelines.

This position requires strong analytical ability, attention to detail, and confidence in challenging questionable claims, excessive billing, or unsupported treatment.

Essential Duties and Responsibilities (include, but are not limited to the following):

Key Responsibilities

• This role primarily handles PIP claims arising in Maryland, with regular exposure to Pennsylvania, Florida, Georgia, Illinois, Virginia, and the District of Columbia. Familiarity with the regulatory frameworks in any of these states is strongly preferred; mastery of Maryland PIP is required
• Review, investigate, and manage PIP claims from initial notice through resolution
• Analyze medical records, treatment plans, billing submissions, police reports, and supporting documentation
• Identify billing irregularities, excessive treatment patterns, duplicate charges, inflated claims, or potential fraud indicators
• Evaluate claim validity and determine exposure based on applicable state PIP regulations and policy guidelines
• Defend against inaccurate, unsupported, or excessive claims through detailed file review and documentation
• Coordinate with attorneys, medical providers, adjusters, third-party administrators, and internal stakeholders
• Negotiate settlements and reductions with providers, attorneys, and claimants when appropriate
• Monitor claim timelines and ensure all statutory deadlines and compliance requirements are met
• Prepare detailed claim notes, summaries, and recommendations for leadership or legal review
• Assist with litigation support and respond to disputes, arbitrations, or audits related to PIP claims
• Identify trends and recommend process improvements to reduce claim leakage and financial exposure
• Maintain accurate claim files and documentation within internal systems

Qualifications Required:

• 3+ years of direct experience handling automotive PIP claims
• Strong knowledge of PIP regulations, medical billing review, and claims investigation practices
• Experience defending against questionable or inflated PIP claims
• Ability to interpret medical records, treatment documentation, and billing codes
• Experience in identifying fraud indicators, provider abuse, or claim inconsistencies
• Strong negotiation and conflict-resolution skills
• Excellent organizational skills and attention to detail
• Ability to manage a high-volume caseload while maintaining accuracy
• Proficient in claims management systems and Microsoft Office / Google Workspace

Preferred Qualifications:

• Experience in rideshare, fleet, rental, or commercial auto claims environments
• Prior experience working with SIU (Special Investigations Unit) teams
• Familiarity with state-specific PIP regulations, especially high-volume PIP states
• Experience working with attorneys and litigation management
• Insurance adjuster license(s) where applicable

Salary: $65,000 - $70,000 per year; depending on experience

Ideal Candidate Profile

The ideal candidate is highly detail-oriented, skeptical in the right ways, and comfortable challenging unsupported claims or questionable documentation. They should be able to balance thorough investigation with efficient claim handling and understand how to reduce unnecessary claim spend without compromising compliance or professionalism.

Originally posted on Himalayas