This is a remote position.
Position Summary:
We are seeking an experienced PIP Claims Handler to manage and investigate Personal Injury Protection (PIP) claims related to automotive accidents. This role is heavily focused on reviewing claims for accuracy, identifying inconsistencies, mitigating fraud exposure, and controlling claim costs while ensuring compliance with state regulations and policy requirements.
The adecuado candidate has extensive experience handling PIP claims within the auto insurance, legal, healthcare billing, or claims administration space and is highly skilled at scrutinizing medical documentation, billing practices, and treatment timelines.
This position requires strong analytical ability, attention to detail, and confidence in challenging questionable claims, excessive billing, or unsupported treatment.
Essential Duties and Responsibilities (include, but are not limited to the following):
Key Responsibilities
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- Review, investigate, and manage PIP claims from initial notice through resolution
- Analyze medical records, treatment plans,
billing submissions, police reports, and supporting documentation
- Identify billing irregularities, excessive treatment patterns, duplicate charges, inflated claims, or potential fraud indicators
- Evaluate claim validity and determine exposure based on applicable state PIP regulations and policy guidelines
- Defend against inaccurate, unsupported, or excessive claims through detailed file review and documentation
- Coordinate with attorneys, medical providers, adjusters, third-party administrators, and internal stakeholders
- Negotiate settlements and reductions with providers, attorneys, and claimants when appropriate
- Monitor claim timelines and ensure all statutory deadlines and compliance requirements are met
- Prepare detailed claim notes, summaries, and recommendations for leadership or legal review
- Assist with litigation support and respond to disputes, arbitrations, or audits related to PIP claim
📌 PIP Claims Handler (México)
🏢 Whip
📍 México