PIP Claims Specialist in Williamsville, NY at National General Insurance

Date Posted: 7/12/2019

Job Snapshot

Job Description

Primary Purpose:

PIP Litigation Specialist

Responsible for evaluating and negotiating the resolution of claims within authority levels while mitigating damages to achieve cost effective claims outcomes. Work location will be either Remote, Cleveland, OH or Williamsville, NY

Essential Duties and Responsibilities:

Following is a summary of the essential functions for this job. Other duties may be performed, both major and minor, which are not mentioned below.

  • Review and handle litigation and arbitration claims for the New York PIP Department
  • Serves as litigation and technical specialist for PIP Claims Department
  • Work with claim handlers and outside counsel toward achieving the most expeditious and cost-efficient resolution possible. Conduct negotiations and settlements within authority level to aid in the resolution.
  • Track and document the quality of service provided by defense counsel and manage litigation and recovery costs.
  • Assist claim handlers and/or their respective managers with research of complex issues and development of defense strategies on litigated files.
  • Attend trials and meditations as appropriate with managerial approval.
  • Direct handle claim files involving complex litigation
  • Analyzes, evaluates and adjusts claims within limit of authority in compliance with statutory regulations and fair claim practices; makes decisions on best options. Summarizes claims in excess of authority and submits to manager for approval.
  • Recognizes how to determine if subrogation exists when additional payments are made and how to handle. May refer claim to appropriate business unit for further handling.
  • Performs other projects and assignments as directed, including, but not limited to, assisting in training PIP trainees and other PIP Reps, with possible attendance at depositions, arbitrations and hearings
  • Review and analysis of medical claims, including, but not limited to, the analysis and interpretation of medical records and reports and utilization of Independent Medical Examinations, peer reviews, case management, coding reviews,/calculation of New York State Fee Schedule and Diagnostic Related Group (DRG) audits.
  • Strong Negotiation Skills
  • Identify potential coverage issues and refer claims to Claims Manager as needed
  • Determine liability and evaluate damages of all exposures related to the claim and document findings of investigation
  • Provide effective and timely communication to all internal and external stakeholders regarding claim status and other inquiries such as fraud and subrogation recovery
  • Support claims workflow efficiency by accurately documenting claim progress, referring high risk exposures outside authority levels and seeking opportunities that enhance operational knowledge
  • Contribute to a positive work environment by demonstrating cultural expectations and influencing others to reward performance and value people, accountability, diversity and inclusion, flexibility, continuous improvement, collaboration, creativity and fun
  • Adopt National General values in personal work behaviors, decision-making, contributions and interpersonal interactions; manage own career development by soliciting feedback and valuing other perspectives
  • Participate in committees, special projects and other duties as assigned
  • Use multiple resources to gather and analyze significant data
  • Maintain integrity of claims portfolio and evidence

Minimum Skills and Competencies:

The requirements listed below are representative of the knowledge, skill and/or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

  • High School Diploma or general education degree (GED)
  • 3 or more years experience handling New York no-fault claims. Knowledge of Regulation 68, Personal Injury Protection law,
  • Proficient in Microsoft Office (Word, Excel, Outlook, PowerPoint)
  • Basic understanding of the principles and processes for providing customer service including meeting quality standards for services and evaluation of customer satisfaction
  • Utilize effective communication to influence and persuade decision makers; understand the needs and goals of customers and actively look for ways to meet them; mediate and resolve conflict
  • Ability to effectively manage one’s own time
  • Ability to leverage technical knowledge to make cost-effective decisions
  • Ability to complete tasks attentively and thoroughly with attention to detail
  • Utilize established procedures to guide decision-making
  • Maintain a professional, poised and positive demeanor

Desired Skills:

  • 6+ years of experience in claims and/or handling auto claims
  • Bachelor’s Degree or in-lieu of degree equivalent education, training and work-related experience.
  • Knowledge of medical terminology, and policy coverage's.
  • Requires a high degree of initiative, mature judgment, and discretion.
  • Ability to resolve conflicts and empathize with customers is critical. Negotiation skills are critical for resolving claims.
  • Demonstrates professional oral and written communication skills.
  • Organization and time management skills are critical for this position.
  • Experience handling NY No Fault Litigation and Arbitration Claims.
  • Demonstrates a solid understanding of insurance law as it relates to claims.
  • Ability to travel to attend Trials, Arbitration's, depositions and any trail related hearings as needed.
  • Possess working knowledge of claims administration best practices and procedures
  • Possess working knowledge of insurance products and services
  • Possess an understanding of relevant laws and regulations across multiple jurisdictions
  • Possess an understanding of market trends and organizational strategies



Job posting ID: 2019-2272

Job Requirements


About National General Holdings:

National General Holdings Corp. is headquartered in New York City. National General traces its roots to 1939, has a financial strength rating of A– (excellent) from A.M. Best, and provides personal and commercial automobile, homeowners, umbrella, recreational vehicle, motorcycle, supplemental health, and other niche insurance products. We are a specialty personal lines insurance holding company. Through our subsidiaries, we provide a variety of insurance products, including personal and commercial automobile, homeowners, umbrella, recreational vehicle, supplemental health, lender-placed and other niche insurance products.

National General is a fast paced, dynamic, and entrepreneurial organization. Our team members live by and exemplify what we call the 4Es. At National General, we are Energized, Engaged, Empowered, and we Execute every day in order to provide an exceptional experience for our customers! We are passionate about our organization and the value that we add every day. A successful candidate with National General will embody the 4Es. Our team is poised to outperform the competition. We are National General Insurance and with us you can be extraordinary! Come join our team!

Companies and Partners

Direct General Auto & Life, Personal Express Insurance, Century-National Insurance, ABC Insurance Agencies, NatGen Preferred, NatGen Premier, Seattle Specialty, National General Lender Services, ARS, RAC Insurance Partners, Mountain Valley Indemnity, New Jersey Skylands, Adirondack Insurance Exchange, VelaPoint, Quotit, HealthCompare, AHCP, NHIC, Healthcare Solutions Team, North Star Marketing, Euro Accident.

In addition to a phenomenal career opportunity, National General Insurance offers an excellent benefits package including:

• Paid Training
• Medical, Dental, Vision benefits
• Wellness Programs
• Life and Short/Long Term Disability Insurance
• 401k w/ Company Match
• Company Paid Holidays & Generous Time-off policy
• Employee Discount Program
• Career Advancement and Development Opportunities
• On-site Healthcare Clinic (Winston-Salem and Cleveland offices)
• On-site Fitness Center (Cleveland and Dallas offices)
• Subsidized parking (Cleveland office)

National General Holdings Corp. is an Equal Opportunity (EO) employer – Veterans/Disabled and other protected categories. All qualified applicants will receive consideration for employment regardless of any characteristic protected by law. Candidates must possess authorization to work in the United States, as it is not our practice to sponsor individuals for work visas.

In the event you need assistance or accommodation in completing your online application, please contact NGIC main office by phone at (336) 435-2000.



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