Personal Injury Protection (PIP) Claims Adjus

The Personal Injury Protection (PIP) Claims Adjuster is responsible for investigating, evaluating, negotiating, and settling Michigan no-fault PIP claims in compliance with state regulations and company standards. The ideal candidate will have a strong understanding of Michigan’s no-fault insurance laws, medical terminology, and claims-handling procedures.

Key Responsibilities:

• Handle a caseload of Michigan PIP claims from start to resolution. Investigate claims by reviewing medical records, police reports, witness statements, and other documentation.
• Determine coverage, liability, and eligibility for medical and wage loss benefits under Michigan no-fault laws.
• Communicate with claimants, attorneys, medical providers, and internal departments in a timely and professional manner.
• Analyze medical bills, wage statements, and other documentation to determine appropriate benefits.
• Negotiate settlements when appropriate and manage litigation when claims are disputed.
• Maintain accurate and detailed claim files in accordance with company and regulatory guidelines.
• Ensure timely payment of benefits and compliance with statutory deadlines (e.g., 30-day payment rule).
• Stay up to date on changes to Michigan no-fault laws, medical fee schedules, and industry best practices.

Qualifications:

Required:

• Minimum 2–3 years of experience handling Michigan PIP claims.
• In-depth knowledge of Michigan no-fault insurance laws (MCL 500.3101 et seq.).
• Strong understanding of medical terminology and billing practice.
• Excellent communication, analytical, negotiation, and decision-making skills.
• Proficient in Microsoft Office and claims management systems.

Preferred:

• Associate’s or Bachelor’s degree.
• Michigan adjuster license (if applicable) or ability to obtain one.
• Experience with litigation or subrogation related to PIP claims.