No-Fault PIP Claims Adjuster - Complex, Law-Backed

Hereford Insurance Company; New York (NY); On-site; USD 50,000 - 60,000; Full time

Job summary

Hereford Insurance Company seeks a highly analytical No-Fault Claims Adjuster in New York. The role focuses on adjusting complex No-Fault claims, following NY Regulations 68, and identifying potential fraud for SIU referral.

The adjuster will manage investigations, vendor procedures, and medical bill reviews, ensuring proper claim handling and timely closures within HIC's No-Fault process.

Qualifications

• Must be conversant in NYS Insurance Department, Regulations 68.
• Familiar with identifying potential fraud claims for SIU referral.
• Familiar with No-Fault forms and processes (IME, peer reviews).
• Knowledge of arbitration, subrogation, and No-Fault litigation processes.

Responsibilities

• Initiate investigative techniques (EUO, SIU) as part of claims handling.
• Forward NF1, NF2 forms upon receiving a new No-Fault claim.
• Make immediate contact with applicant or representative to gather information.
• Index all No-Fault applicants (ISO) and monitor responses.
• Maintain a diary of all files assigned to the adjuster.
• Review No-Fault communications on assigned files.
• Review and monitor files for closing.
• Review medical and expense bills for duplication and issue payments as appropriate.
• Follow No-Fault Vendor procedures for IME initiation.
• Medically manage through IME and peer reviews and verification requests.
• Request six-month EOBs and document files with action plans.

Skills

No-Fault claims adjusting

Analytical thinking

Communication skills

Tools

Windows

Job description

Hereford Insurance Company seeks a highly analytical No-Fault Claims Adjuster in New York. The role focuses on adjusting complex No-Fault claims, following NY Regulations 68, and identifying potential fraud for SIU referral.

The adjuster will manage investigations, vendor procedures, and medical bill reviews, ensuring proper claim handling and timely closures within HIC's No-Fault process.