No-Fault (PIP) Senior Adjuster

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    "requisitionDescription": "<div><div><p><br></p><p style=\"margin-left:0in;\" data-pasted=\"true\"><strong>Position Summary:</strong> We are seeking an experienced Senior No-Fault Adjuster with extensive knowledge of New York No-Fault/PIP claims handling. The ideal candidate will possess a minimum of 5 years of New York No-Fault claims experience and demonstrate strong investigative, analytical, and organizational skills.</p><p style=\"margin-left:0in;\">This position requires the ability to independently manage complex claims, interpret New York No-Fault regulations, evaluate medical documentation, address coverage issues, and effectively communicate with providers, attorneys, insureds, and internal departments.</p><p style=\"margin-left:0in;\">Experience handling claims involving transportation network, livery, black car, taxi, or for-hire vehicle exposures is strongly preferred. Familiarity with Workers&rsquo; Compensation and Black Car Fund-related coverage issues is also highly desirable, particularly where questions arise regarding primary coverage determinations between Workers&rsquo; Compensation and No-Fault benefits.</p><p style=\"margin-left:0in;\"><strong>Essential Duties and Responsibilities</strong></p><p style=\"margin-left:0in;\"><strong>No-Fault Claims Handling</strong></p><ul type=\"disc\"><li style=\"margin-left:0in;\">Independently manage a pending inventory of New York No-Fault/PIP claims from inception through resolution.&nbsp;</li><li style=\"margin-left:0in;\">Review and evaluate medical bills, lost wage claims, and supporting documentation for compensability and compliance with New York No-Fault regulations.&nbsp;</li><li style=\"margin-left:0in;\">Issue timely claim determinations, denials, verification requests, and payment authorizations in accordance with statutory timeframes.&nbsp;</li><li style=\"margin-left:0in;\">Investigate and evaluate coverage issues, including priority of coverage and policy applicability.&nbsp;</li><li style=\"margin-left:0in;\">Review police reports, EUO transcripts, IME reports, medical records, wage documentation, and provider submissions.&nbsp;</li><li style=\"margin-left:0in;\">Coordinate and monitor Examinations Under Oath (EUOs), Independent Medical Examinations (IMEs), and peer reviews.&nbsp;</li><li style=\"margin-left:0in;\">Identify potential fraud indicators and refer suspicious claims for SIU investigation when appropriate.&nbsp;</li><li style=\"margin-left:0in;\">Maintain accurate claim documentation and detailed file notes.&nbsp;</li></ul><p style=\"margin-left:0in;\"><strong>Workers&rsquo; Compensation / Black Car Fund Exposure</strong></p><ul type=\"disc\"><li style=\"margin-left:0in;\">Handle claims involving overlapping No-Fault and Workers&rsquo; Compensation exposure.&nbsp;</li><li style=\"margin-left:0in;\">Review and assess claims where Workers&rsquo; Compensation or the Black Car Fund may be primary for medical and wage benefits.&nbsp;</li><li style=\"margin-left:0in;\">Coordinate with Workers&rsquo; Compensation carriers, attorneys, employers, and the New York State Workers&rsquo; Compensation Board regarding compensability and coverage determinations.&nbsp;</li><li style=\"margin-left:0in;\">Evaluate the impact of Workers&rsquo; Compensation Board decisions on No-Fault exposure and reimbursement rights.&nbsp;</li><li style=\"margin-left:0in;\">Identify and pursue transfer of responsibility when Workers&rsquo; Compensation is deemed primary.&nbsp;</li></ul><p style=\"margin-left:0in;\"><strong>Customer Service &amp; Communication</strong></p><ul type=\"disc\"><li style=\"margin-left:0in;\">Communicate professionally and effectively with insureds, claimants, attorneys, medical providers, brokers, and internal departments.&nbsp;</li><li style=\"margin-left:0in;\">Respond timely to inquiries and maintain strong customer service standards.&nbsp;</li><li style=\"margin-left:0in;\">Provide guidance and mentorship to junior adjusters and support staff as needed.&nbsp;</li></ul><p style=\"margin-left:0in;\"><strong>Other Duties</strong></p><div style=\"margin-left:0in;\"><ul style=\"list-style-type: disc;\"><li style=\"margin-left:0in;\">This job description in no way states or implies that these are the only duties to be performed. You will be expected to follow any other job-related instructions and to perform other job-related duties as requested by your supervisor.</li></ul></div><p style=\"margin-left:0in;\"><strong>Qualifications</strong></p><p style=\"margin-left:0in;\"><strong>Required</strong></p><ul type=\"disc\"><li style=\"margin-left:0in;\">Minimum of 5 years of New York No-Fault/PIP claims handling experience.&nbsp;</li><li style=\"margin-left:0in;\">Strong working knowledge of New York No-Fault regulations and claim handling requirements.&nbsp;</li><li style=\"margin-left:0in;\">Experience managing complex No-Fault claims independently.&nbsp;</li><li style=\"margin-left:0in;\">Knowledge of arbitration and litigation processes related to No-Fault claims.&nbsp;</li><li style=\"margin-left:0in;\">Excellent written and verbal communication skills.&nbsp;</li><li style=\"margin-left:0in;\">Strong organizational skills and ability to manage deadlines in a fast-paced environment.&nbsp;</li><li style=\"margin-left:0in;\">Proficiency with claim management systems and Microsoft Office applications.&nbsp;</li></ul><p style=\"margin-left:0in;\"><strong>Preferred</strong></p><ul type=\"disc\"><li style=\"margin-left:0in;\">Experience handling for-hire vehicles, livery, taxi, rideshare, or transportation-related claims.&nbsp;</li><li style=\"margin-left:0in;\">Familiarity with Workers&rsquo; Compensation claims handling and Workers&rsquo; Compensation Board procedures.&nbsp;</li><li style=\"margin-left:0in;\">Experience addressing Black Car Fund coverage and priority disputes.&nbsp;</li><li style=\"margin-left:0in;\">Knowledge of transfer of coverage and reimbursement recovery processes between No-Fault and Workers&rsquo; Compensation carriers.&nbsp;</li><li style=\"margin-left:0in;\">SIU/fraud investigation exposure.&nbsp;</li></ul><p style=\"margin-left:0in;\"><strong>Education</strong></p><ul type=\"disc\"><li style=\"margin-left:0in;\">High school diploma or equivalent required.&nbsp;</li><li style=\"margin-left:0in;\">Bachelor&rsquo;s degree preferred but not required based on experience.&nbsp;</li></ul><p style=\"margin-left:.25in;\"><strong>* Please note that this is a Hybrid role, requiring up to two days per week onsite. *</strong></p><p style=\"margin-left:0in;\"><br></p><p><br></p></div></div>\n",
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