Adjuster PIP - Consultant Casualty Claims

Our Claims team is currently seeking an Adjuster PIP - Consultant Casualty Claims.

This is a full-time, exempt role with a hybrid work schedule (two days in the office) in one of our Hanover offices:

• Howell, MI

• Southfield, MI

• Grand Rapids, MI

POSITION OVERVIEW: 

The Consultant Casualty Claims is responsible for managing no-fault claims that typically involve minimal to moderate injury and disability severity. Duties include verifying coverage, evaluating medical bills and applicable no-fault benefits for payment, and maintaining clear communication with claimants, third parties and providers. Claims may also involve negotiating settlements, handling of basic disputes, and/or arbitration.

IN THIS ROLE, YOU WILL:

• Manage a caseload of moderately complex casualty claims from intake through resolution.
• Conduct thorough investigations, assess liability, and evaluate damages using established procedures.
• Collaborate with underwriting, legal, and internal/external stakeholders as needed to ensure comprehensive claim evaluation.
• Identify and refer potentially suspicious claims to the Special Investigations Unit.
• Apply comparative negligence laws and state-specific regulations to claim assessments.
• Set reserves, authorize payments, and demonstrate financial acumen within scope of authority.
• Utilize technology and data tools to enhance claims processing efficiency and accuracy.
• Communicate directly with claimants, legal representatives, and third parties to negotiate fair resolutions.
• Maintain detailed and compliant documentation of claim activities and communications.
• Participate in team collaboration, problem-solving discussions, and cross-functional coordination.
• Support subrogation efforts and risk transfer opportunities to benefit insureds and business partners.
• Handle sensitive communications professionally and translate complex information for diverse audiences.
• Mentor entry-level claim handlers and share best practices learned through training and experience.
• Attend ongoing training and education to maintain licensing and stay current on industry standards.
• Independently manage indemnity, medical, and basic arbitration or mediation components of claims with supervisory support.
• Must possess or obtain and maintain appropriate state adjuster licenses.

WHAT YOU NEED TO APPLY: 

• Associate degree required; bachelor's degree preferred or combination of education and experience.
• Typically has 1-4 years of relevant claims handling experience. 
• Conduct independent analysis of contractual indemnification. 
• Independently execute indemnity, medical, litigation/resolution management. 
• Proficient with basic computer navigation; ability to use basic software systems/applications (Suite of MS Office Products) and use of internet. 
• Learn and handle negotiations independently within authority, understand common tactics for moderately complex claim resolution. 
• Use judgement and effectively utilize the most suitable communication channel while displaying empathy towards all stakeholders.    
• Knowledge of various types of insurance products and processes. 
• Conduct thorough investigations; identify key issues and gather evidence. 
• Provide effective empathetic customer service; handle routine inquiries and issues. 

Core Capabilities: 

• Analytical Reasoning: The ability to identify problems, understand your impact, gather input and data, and develop an effective solution.

• Customer Centricity: Makes customers/clients and their needs a primary focus of one’s actions; shows interest in and understanding of the needs and expectations of internal and external customers; gains customer trust and respect; meets or  exceeds customer expectations.

• Digital Fluency: Effectively uses digital tools and technology appropriately to find, evaluate, create, and communicate information understands how to navigate digital platforms, use software applications, and leverage technology for productivity and communication purposes.

• Persuasion and Influence: Uses appropriate interpersonal skills and techniques to gain acceptance for ideas or solutions; uses influencing strategies to gain genuine agreements; seeks to persuade rather than force solutions or impose decisions or regulations.

• Professional Insurance Acumen: Demonstrates a deepening understanding of the insurance industry and the ability to apply specialized technical skills to address complex challenges, adapt to industry trends, and drive value for the organization.

• Planning and Execution: Plans, prioritizes and manages resources and time effectively to achieve specific goals or deadlines.