Sr. Claims Specialist

BP&C • Albany, NY

1d • $60,000 - $106,000 • Hybrid

About The Position

Purpose of the Role The Claims Specialist is responsible for the end‑to‑end handling of New York Personal Injury Protection (PIP) claims, from initial investigation through resolution. Working with a high degree of autonomy, this role focuses on accurate coverage determination, compliance with New York no‑fault regulations, and fair, timely claim outcomes. The Specialist manages moderate to high‑complexity PIP claims and collaborates closely with internal partners, medical providers, vendors, and defense counsel as needed.

Requirements

• 6+ years of claims handling experience, handling New York PIP claims.
• In‑depth knowledge of New York insurance regulations, PIP statutes, and medical billing practices
• Experience evaluating medical records, treatment plans, and claim disputes
• Active adjuster license and ability to maintain required continuing education
• Strong negotiation, analytical, and written communication skills

Nice To Haves

• Bachelor’s degree or equivalent professional experience
• Insurance designations or formal training in claims
• Experience handling higher‑exposure or litigated PIP claims

Responsibilities

• Investigate, evaluate, negotiate, and resolve New York PIP claims in compliance with state statutes, regulations, and case law
• Handle PIP Arbitration and Lawsuits
• Confirm coverage, review facts of loss, and assess damages and medical necessity
• Review and process medical bills, applying fee schedules, coding standards, and cost‑containment methodologies
• Evaluate claim complexity and exposure; escalate or refer matters appropriately
• Communicate directly with claimants, attorneys, medical providers, and vendors
• Negotiate settlements and ensure proper documentation, releases, and regulatory timeframes
• Identify and address coverage, liability, or fraud indicators when present
• Maintain accurate claim documentation and meet regulatory and internal service standards
• Mentor or provide guidance to junior adjusters

Benefits

• We offer a competitive compensation package, performance-based incentives, and a comprehensive benefits program—including health, dental, vision, 401(k) with company match, paid time off, and professional development opportunities.

What This Job Offers

• Job Type: Full-time
• Career Level: Mid Level