[Hiring] Executive Claims Specialist @Crum & Forster

Role 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.

• 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.

Qualifications

• 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.

Benefits

• 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, focused on your whole family’s wellness.
• Opportunities for career development, including tuition reimbursement, industry-related certifications and professional training.
• A dynamic, ambitious, fun and exciting work environment.
• Encouragement of social and community responsibility through matching donation program, volunteer opportunities, and an employee-driven corporate giving program.