Job Description
Position Summary: 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.
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.
Experience handling claims involving transportation network, livery, black car, taxi, or for-hire vehicle exposures is strongly preferred. Familiarity with Workers’ Compensation and Black Car Fund-related coverage issues is also highly desirable, particularly where questions arise regarding primary coverage determinations between Workers’ Compensation and No-Fault benefits.
Essential Duties and Responsibilities
No-Fault Claims Handling
- Independently manage a pending inventory of New York No-Fault/PIP claims from inception through resolution.
- Review and evaluate medical bills, lost wage claims, and supporting documentation for compensability and compliance with New York No-Fault regulations.
- Issue timely claim determinations, denials, verification requests, and payment authorizations in accordance with statutory timeframes.
- Investigate and evaluate coverage issues, including priority of coverage and policy applicability.
- Review police reports, EUO transcripts, IME reports, medical records, wage documentation, and provider submissions.
- Coordinate and monitor Examinations Under Oath (EUOs), Independent Medical Examinations (IMEs), and peer reviews.
- Identify potential fraud indicators and refer suspicious claims for SIU investigation when appropriate.
- Maintain accurate claim documentation and detailed file notes.
Workers’ Compensation / Black Car Fund Exposure
- Handle claims involving overlapping No-Fault and Workers’ Compensation exposure.
- Review and assess claims where Workers’ Compensation or the Black Car Fund may be primary for medical and wage benefits.
- Coordinate with Workers’ Compensation carriers, attorneys, employers, and the New York State Workers’ Compensation Board regarding compensability and coverage determinations.
- Evaluate the impact of Workers’ Compensation Board decisions on No-Fault exposure and reimbursement rights.
- Identify and pursue transfer of responsibility when Workers’ Compensation is deemed primary.
Customer Service & Communication
- Communicate professionally and effectively with insureds, claimants, attorneys, medical providers, brokers, and internal departments.
- Respond timely to inquiries and maintain strong customer service standards.
- Provide guidance and mentorship to junior adjusters and support staff as needed.
Other Duties
- 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.
Qualifications
Required
- Minimum of 5 years of New York No-Fault/PIP claims handling experience.
- Strong working knowledge of New York No-Fault regulations and claim handling requirements.
- Experience managing complex No-Fault claims independently.
- Knowledge of arbitration and litigation processes related to No-Fault claims.
- Excellent written and verbal communication skills.
- Strong organizational skills and ability to manage deadlines in a fast-paced environment.
- Proficiency with claim management systems and Microsoft Office applications.
Preferred
- Experience handling for-hire vehicles, livery, taxi, rideshare, or transportation-related claims.
- Familiarity with Workers’ Compensation claims handling and Workers’ Compensation Board procedures.
- Experience addressing Black Car Fund coverage and priority disputes.
- Knowledge of transfer of coverage and reimbursement recovery processes between No-Fault and Workers’ Compensation carriers.
- SIU/fraud investigation exposure.
Education
- High school diploma or equivalent required.
- Bachelor’s degree preferred but not required based on experience.
* Please note that this is a Hybrid role, requiring up to two days per week onsite. *