PIP Claims Handler

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 ideal 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

This role primarily handles PIP claims arising in Maryland, with regular exposure to Pennsylvania, Florida, Georgia, Illinois, Virginia, and the District of Columbia. Familiarity with the regulatory frameworks in any of these states is strongly preferred; mastery of Maryland PIP is required

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 claims

Identify trends and recommend process improvements to reduce claim leakage and financial exposure

Maintain accurate claim files and documentation within internal systems

Qualifications Required:

3+ years of direct experience handling automotive PIP claims

Strong knowledge of PIP regulations, medical billing review, and claims investigation practices

Experience defending against questionable or inflated PIP claims

Ability to interpret medical records, treatment documentation, and billing codes

Experience in identifying fraud indicators, provider abuse, or claim inconsistencies

Strong negotiation and conflict-resolution skills

Excellent organizational skills and attention to detail

Ability to manage a high-volume caseload while maintaining accuracy

Proficient in claims management systems and Microsoft Office / Google Workspace

Preferred Qualifications:

Experience in rideshare, fleet, rental, or commercial auto claims environments

Prior experience working with SIU (Special Investigations Unit) teams

Familiarity with state-specific PIP regulations, especially high-volume PIP states

Experience working with attorneys and litigation management

Insurance adjuster license(s) where applicable

Salary: $65,000 - $70,000 per year; depending on experience
Ideal Candidate Profile
The ideal candidate is highly detail-oriented, skeptical in the right ways, and comfortable challenging unsupported claims or questionable documentation. They should be able to balance thorough investigation with efficient claim handling and understand how to reduce unnecessary claim spend without compromising compliance or professionalism.
Originally posted on Himalayas