We are seeking a highly skilled PIP Claims Representative to join our dynamic team. This role is crucial in guiding our Florida NSA customers through the claims journey, helping them recover from the unexpected, and ensuring fair and accurate claim resolution. You will play a vital role in upholding our commitment to tech-driven efficiency, proactive fraud prevention, and adapting to Florida's unique legal landscape, particularly concerning Personal Injury Protection (PIP) and recent tort reforms (HB 837).

What You Will Do:

• Customer-Centric Claims Management: Review assigned claims, make prompt first contact with the insured and other affected parties, set clear expectations for the claim, and accurately document all interactions in our claims handling system.
• Comprehensive Coverage and Liability Analysis: Complete thorough coverage analysis, reviewing policy coverages and provisions, and their applicability to the reported loss. Leverage a deep understanding of the NSA customer profile during investigations.
• Proactive Fraud Detection & Investigation: Conduct in-depth investigations, identifying inconsistencies, suspicious circumstances, or red flags to uncover potential fraud indicators from day one. You will refer high-risk claims to our internal Special Investigations Unit (SIU) promptly.
• Damage and Valuation Expertise: Conduct thorough reviews of damages, determine the applicability of Florida state law and other relevant factors, and evaluate the financial value of losses. Approve payments to appropriate parties.
• PIP Management & Regulatory Compliance: Oversee the management of PIP claims, ensuring strict adherence to Florida's unique regulatory and legal landscape. This includes deductible handling, Coordination of Benefits (COB) logic, and applying Florida's Medical Fee Schedule directly into our systems.
• Complex Claim Resolution: Manage complex and high-value PIP claims, including those involving catastrophic injuries, multiple parties, or significant litigation exposure. Provide guidance and expertise where needed.
• Litigation Strategy & Risk Mitigation: Apply expert knowledge of PIP claims processes, regulations, and legal principles to navigate the post-HB 837 environment. This includes accounting for modified comparative negligence and leveraging the 90-day safe harbor for bad faith claims.
• Cross-Functional Collaboration: Collaborate effectively with internal teams such as Underwriting, Recovery Units, SIU, legal counsel, and product & technology teams to ensure seamless claim handling, mitigate risk, and reduce claims costs.
• Data-Driven Adaptation: Utilize our tech-driven tools to capture detailed information, identify trends, and contribute to continuous process improvement and adaptation to emerging challenges in the Florida market.
• System Documentation & Negotiation: Thoroughly document and/or code claim files and complete all claim closure activities in the assigned claims management system. Utilize strong negotiating skills to achieve favorable outcomes.
• Leadership & Mentorship (for Senior/Lead candidates): Provide guidance, direction, and expertise to the claims team. Serve as a subject matter expert, develop and implement policies/procedures, and monitor KPIs to track departmental performance. Offer coaching, training, and professional development opportunities for claims staff, fostering a culture of continuous improvement.

What You Have:

• ​Bachelor's degree in business administration, insurance, or a related field preferred.
• At least 5+ years of progressive experience in PIP claims management, with a proven track record of successful claim resolution.
• Advanced degree or professional designation (e.g., CPCU, AIC) is preferred.
• Expert Knowledge: Expert knowledge of Florida PIP claims processes, regulations, and legal principles, including recent tort reforms (HB 837) and AOB legislation. Expert knowledge and usage of Mitchell Decision Point systems specific to Florida handling.
• Analytical & Problem-Solving Skills: Excellent analytical and problem-solving abilities, with the capacity to analyze complex issues and develop innovative solutions. You excel at "reading between the lines" to uncover critical details.
• Communication & Interpersonal Skills: Exceptional communication and interpersonal skills, with the ability to interact professionally with all levels of the organization and external stakeholders, including financially strained NSA consumers. Bi-lingual capabilities (English/Spanish) are highly valued due to Florida's significant Spanish-speaking population.
• Tech-Savvy: Comfort and proficiency with leveraging technology and AI tools for claims automation, data analysis, and communication (e.g., Snapsheet, Mitchell, chatbots, virtual assistants).
• Litigation Experience: Litigation experience preferred.

But wait, there’s more:

As a people-first company, your health and well-being is a priority at Clearcover. We offer comprehensive benefits and perks for employees :

• Medical. We offer rich and affordable BCBS plans for you and your dependents. If you select the high deductible health plan, we offer an HRA and contribute to your HSA.
• Dental and vision. We cover 100% of dental and vision premiums for you and your dependents.
• Pre-tax benefits, disability, and life insurance.
• 401(k). We contribute 3%, even if you contribute nothing.
• Generous vacation, 12 paid holidays, and parental leave.
• Equity in the company and an annual bonus program.

We’re a remote first company, having paved the way for flexible work locations and continue to offer this flexibility. If you are local or in town visiting, you also have the choice to work from our Chicago HQ office. Because we are a remote first company, we ask that your internet can keep up with our pace.

To top it all off, if Clearcover is available in your state, you could have access to an employee discount on auto-insurance! Excited to learn more? Complete the application below!

Clearcover is an Equal Opportunity Employer (EOE) that welcomes and encourages all applicants to apply regardless of age, race, color, religion, sex, sexual orientation, gender identity and/or expression, national origin, disability, veteran status, marital or parental status, ancestry, citizenship status, pregnancy or other reasons prohibited by law.