执行索赔专家,PIP,远程
Executive Claims Specialist, PIP, Remote
Crum & Forster 公司简介
Crum & Forster(C&F)自1822年以来一直有着辉煌的历史,通过我们的承保和超额线保险公司提供专业和标准的商业保险产品。C&F 获得了 AM Best 机构授予的“ A+”(优秀)财务实力评级,并自豪于其卓越的客户服务系统。我们的理赔和风险工程服务在业内被公认为最优秀的之一。
我们最有价值的资产是员工:全美多个地点有超过2000名员工。公司正日益获得作为优秀工作场所的认可,赢得了多项职场和健康奖项,包括2025年 Great Place to Work® 奖,以表彰我们以员工为先的专注以及对多元化、公平性和包容性的坚定承诺。
C&F 是 Fairfax Financial Holdings 的一部分,这是一家全球性、十亿美元级的组织。如需了解有关 Crum & Forster 的更多信息,请访问我们的网站:www.cfins.com。
职位描述
S&S 交通运输与共享经济部门正在寻找一位经验丰富的高级理赔专家 – 人身伤害赔偿 / 无过失保险,为我们在共享经济项目中的个人伤害赔偿(PIP)理赔提供高级别的技术监督。该职位主要支持多个州的业务,其中新泽西州、纽约州和宾夕法尼亚州的无过失经验尤为优先。理想的候选人应是一位经验丰富的 PIP 专业人士,具备强大的技术判断力、诉讼和仲裁经验,并能够与第三方理赔管理公司和其他相关方有效合作,以促进高质量的理赔结果。这是一个监督和技术领导角色,而非传统的理赔生产岗位。
您将在 C&F 做以下工作:
- 为由第三方理赔管理公司处理的 PIP/无过失理赔提供高级别的技术监督。
- 作为 PIP 相关问题的专家资源,包括保险范围、医疗福利、治疗争议、医疗必要性、同行评审、独立医学检查(IME)、拒赔和监管要求。
- 对复杂、有争议、涉及诉讼和仲裁的 PIP 事项提供技术指导。
- 评估保险覆盖范围、福利资格、保险优先顺序及潜在的风险转移机会。
- 审核理赔处理的准确性、及时性、文档记录以及符合相关法律和监管要求的情况。
- 与 TPA 理赔专业人员和管理层合作,解决理赔处理问题,强化项目期望。
查看英文原文
Crum & Forster Company Overview
Crum & Forster (C&F), with a proud history dating to 1822, provides specialty and standard commercial lines insurance products through our admitted and surplus lines insurance companies. C&F enjoys a financial strength rating of "A+" (Superior) by AM Best and is proud of our superior customer service platform. Our claims and risk engineering services are recognized as among the best in the industry.
Our most valuable asset is our people: more than 2000 employees in locations throughout the United States. The company is increasingly winning recognition as a great place to work, earning several workplace and wellness awards, including the 2025 Great Place to Work® Award for our employee-first focus and our steadfast commitment to diversity, equity and Inclusion.
C&F is part of Fairfax Financial Holdings, a global, billion dollar organization. For more information about Crum & Forster, please visit our website: www.cfins.com.
Job Description
S&S Transportation & Sharing Economy is seeking an experienced Executive Claims Specialist – Personal Injury Protection / No-Fault to provide senior-level technical oversight of Personal Injury Protection (PIP) claims within our sharing economy program. This position will primarily support multiple states with New Jersey, New York and Pennsylvania no-fault experience strongly preferred. The ideal candidate is a seasoned PIP professional with strong technical judgment, litigation and arbitration experience, and the ability to partner effectively with Third-Party Administrators and other stakeholders to promote quality claim outcomes. This is an oversight and technical leadership role rather than a traditional claim-production position.
What you will do for C&F:
- Provide senior-level technical oversight of PIP/no-fault claims administered by Third-Party Administrators.
- Serve as a subject matter resource for PIP, including coverage, medical benefits, treatment disputes, medical necessities, peer reviews, IMEs, denials and regulatory requirements.
- Provide technical guidance on complex, disputed, litigated and arbitrated PIP matters.
- Evaluate coverage, benefit eligibility, priority of coverage and potential risk-transfer opportunities.
- Review claim handling for accuracy, timeliness, documentation and compliance with applicable statutory and regulatory requirements.
- Partner with TPA claim professionals and leadership to address claim handling concerns, reinforce program expectations and identify opportunities for improvement.
- Conduct targeted claim audits and quality reviews.
- Evaluate reserve adequacy and provide technical recommendations on complex exposures.
- Identify trends involving providers, litigation, claim handling, leakage, compliance and emerging exposures.
- Coordinate with Legal, SIU, medical review vendors, defense counsel and other internal and external partners as appropriate.
- Support enhancements to claim guidelines, workflows, reporting, training and quality controls.
- Maintain awareness of legislative, regulatory and judicial developments affecting PIP/no-fault claims.
What you will bring to C&F:
- 6+ years (8-10 preferred) of progressively responsible PIP/no-fault claims experience, including complex or technically advanced matters.
- Extensive hands-on New Jersey, New York and/or Pennsylvania no-fault experience strongly preferred.
- Strong knowledge of medical management, coverage, treatment disputes, benefit denials and regulatory compliance.
- Significant PIP litigation and arbitration experience.
- Experience with TPA oversight, carrier technical claims, quality assurance or similar program oversight preferred.
- Commercial auto experience. Rideshare, transportation network company or sharing economy experience is a plus but not required.
- Strong analytical, written and verbal communication skills.
- Bachelor’s degree required. CPCU, AIC, SCLA, law degree or other relevant professional designation is a plus.
- Occasional travel may be required.
What C&F will bring to you
- Competitive compensation package
- Generous 401K employer match
- Employee Stock Purchase plan with employer matching
- Generous Paid Time Off
- Excellent benefits that go beyond health, dental & vision. Our programs are focused on your whole family’s wellness, including your physical, mental and financial wellbeing
- A core C&F tenet is owning your career development, so we provide a wealth of ways for you to keep learning, including tuition reimbursement, industry-related certifications and professional training to keep you progressing on your chosen path
- A dynamic, ambitious, fun and exciting work environment
- We believe you do well by doing good and want to encourage a spirit of social and community responsibility, matching donation program, volunteer opportunities, and an employee-driven corporate giving program that lets you participate and support your community
At C&F you will BELONG
If you require special accommodations, please let us know. We value inclusivity and diversity. We are committed to equal employment opportunity and welcome everyone regardless of race, color, ancestry, religion, sex, national origin, sexual orientation, age, citizenship, marital status, disability, gender identity, or Veteran status. If you require special accommodations, please let us know
For California Residents Only: Information collected and processed as part of your career profile and any job applications you choose to submit are subject to our privacy notices and policies, visit for more information.
Crum & Forster is committed to ensuring a workplace free from discriminatory pay disparities and complying with applicable pay equity laws. Salary ranges are available for all positions at this location, taking into account roles with a comparable level of responsibility and impact in the relevant labor market and these salary ranges are regularly reviewed and adjusted in accordance with prevailing market conditions. The annualized base pay for the advertised position, located in the specified area, ranges from a minimum of $64,700.00 to a maximum of $121,600.00. The actual compensation is determined by various factors, including but not limited to the market pay for the jobs at each level, the responsibilities and skills required for each job, and the employee’s contribution (performance) in that role. To be considered within market range, a salary is at or above the minimum of the range. You may also have the opportunity to participate in discretionary equity (stock) based compensation and/or performance-based variable pay programs.
Originally posted on Himalayas