Sr. Claims Examiner - PIP and Bodily Injury Claims Adjuster

Sr. Claims Examiner – PIP & Bodily Injury Claims Adjuster

This position is primarily responsible for the direct handling of PIP claims with secondary responsibilities for light to moderate Auto Bodily Injury claims. The role must gather all necessary information to make informed and responsible decisions, bringing PIP claims to an appropriate resolution and occasionally doing the same for limited BI claims.

• Ensure compliance with established claim‑handling guidelines regarding coverage, investigation, liability, damages, evaluation, and resolution.
• Evaluate the nature and severity of PIP claims; review medical bills, lost wages, and other expenses to determine eligibility for coverage based on policy terms, state regulations, and claim specifics.
• Negotiate by developing a PIP settlement strategy and negotiating with the claimant, their employer, and/or legal counsel.
• Keep track of the PIP log to ensure proper medical payments are made by the available coverage.
• Utilize critical thinking and solid judgment to solve problems, make decisions, and resolve issues inherent in handling PIP and Bodily Injury losses, while planning and organizing activities throughout the claim’s management process.
• Draft declination, reservation of rights, and other coverage letters.
• Establish reserves pursuant to the established reserving protocols and reserve authority procedures.
• Investigate commercial claims while following corporate standards and guidelines.
• Communicate with policyholders and third‑party claimants to reach fair and reasonable settlements.
• Review and negotiate material‑damage appraisals with mechanics, repair shops, or similar vendors.
• Undertake other duties from time to time as reasonably required by the company.

• Analyze Commercial Policy coverages, liability, and damages.
• Possess a comprehensive understanding of state and federal laws, including legislation applicable to PIP and Auto Bodily Injury claims.
• Have an in-depth understanding of policy language/coverage applicable to Commercial Auto Garage and General Liability claims.
• Work independently while managing time and resources to accomplish multiple tasks in a fast‑paced, deadline‑oriented environment.
• Maintain good working knowledge of MS Office, Excel, and Word.

• Insurance adjuster’s license required.
• College degree or equivalent work experience required.
• Minimum of 5 years’ experience handling PIP claims required.
• PIP litigation handling preferred.
• Experience handling Bodily Injury claims preferred.
• Ability to travel occasionally.
• Strong negotiation and persuasive skills.
• Detail‑oriented with accurate record maintenance for payment transactions and settlement offers.
• Effective oral and written communication skills.
• Strong time‑management skills for time‑sensitive tasks.

Applicants must be authorized to work for any employer in the U.S.
We are unable to sponsor or take over sponsorship of an employment Visa for this position.

At Core Specialty, you will receive a competitive salary and opportunities for professional development and advancement. We offer medical, dental, vision, and life insurance; short and long‑term disability; a company‑match of 100% of a 6% contribution 401(k) plan; an Employee Assistance Plan;
Health Savings Account, Flexible Spending Account, Health Reimbursement Account, and a wellness program.