Hybrid PIP & Med-Pay Claims Specialist II

Liberty Mutual Insurance; Westborough (MA); Hybrid; USD 65,000 - 90,000; Full time

Job summary

Liberty Mutual Insurance is seeking a Claims Specialist in a hybrid workplace to analyze PIP and Med-Pay No Fault claims, determine benefits, and manage a caseload from investigation through resolution. You will interact with claimants, policyholders, providers, attorneys, and others to ensure service standards are met.

The role emphasizes collaborative, in-person and remote work, ongoing training, and compliance with licensing requirements, with opportunities for professional development within

Qualifications

• BS/BA degree or equivalent work experience.
• Minimum of 2 years’ experience in claims adjustment, general insurance or formal claims training.
• Required to obtain and maintain all applicable licenses.
• Continuing education courses leading to industry certifications preferred (e.g., AEI, IIA, CPCU).
• Knowledge of claims investigation techniques, medical terminology and legal aspects of claims.

Responsibilities

• Manages an inventory of claims.
• Establishes action plan based on case facts, best practices, protocols, regulatory issues and available resources.
• Plans and conduct investigations of claims to confirm coverage and eligibility to medically manage the claims through resolution.
• Assesses policy coverage for submitted claims and notifies the insured of any issues; determines and establishes reserve requirements, adjusting reserves, as necessary, during the processing of the claim, refers claims to the subrogation group or Special Investigations Unit as appropriate.
• Assesses actual damages associated with claims and conducts negotiations, within assigned authority limits, to settle claims.
• Performs other duties as assigned.

Skills

Claims investigation techniques

Medical terminology

Legal aspects of claims

Education

BS/BA degree or equivalent work experience

Job description

Liberty Mutual Insurance is seeking a Claims Specialist in a hybrid workplace to analyze PIP and Med-Pay No Fault claims, determine benefits, and manage a caseload from investigation through resolution. You will interact with claimants, policyholders, providers, attorneys, and others to ensure service standards are met.

The role emphasizes collaborative, in-person and remote work, ongoing training, and compliance with licensing requirements, with opportunities for professional development within