Senior PIP Adjuster (Texas Claims)
Description: Description Aspire General Insurance Company and its affiliated general agent, Aspire General Insurance Services, are on a mission to deliver affordable specialty auto coverage to drivers without compromising outstanding service.Our company values can best be described with ABLE: to always do the right thing, be yourself, learn and evolve, and execute. Join our team where every individual takes pride in driving their role for shared success. Position Summary Looking for candidate with extensive Texas Personal Injury Protection (PIP) experience. The Senior Personal Injury Protection (PIP) Adjuster is responsible for the prompt, accurate, and compliant handling of complex PIP claims in the state of Texas. This role requires deep expertise in Texas PIP regulations, strong investigative skills, and the ability to manage high-exposure claims while delivering excellent customer service. Ideal candidate will assist with standing up our Personal Injury Protection (PIP) department. Medical Payments (MP) experience in other states is a plus.
Key Responsibilities
- Investigate, evaluate, and adjust PIP claims in accordance with Texas laws and company guidelines
- Obtains information necessary to properly investigate and evaluate each case by corresponding with brokers, insureds, claimants, witnesses and others
- Analyze medical records, billing, and documentation to determine coverage, liability, and damages
- Ensure compliance with Texas Department of Insurance regulations and statutory deadlines
- Handle complex and litigated PIP claims, including disputes and arbitration
- Communicate effectively with claimants, attorneys, medical providers, and internal stakeholders
- Review and negotiate medical bills and treatment plans for reasonableness and necessity
- Identify potential fraud indicators and escalate as appropriate
- Maintain accurate and timely claim file documentation
- Provide guidance and mentorship to junior adjusters as needed
- Manage claim inventory to meet productivity and quality standards
Requirements:
Qualifications
- 5+ years of PIP claims handling experience, with strong focus on Texas claims
- In-depth knowledge of Texas PIP statutes, fee schedules, and compliance requirements
- Experience handling complex, litigated, or high-exposure claims
- Active Texas Adjuster License (required)
- Strong analytical, negotiation, and decision-making skills
- Excellent written and verbal communication abilities
- Ability to manage a high-volume caseload in a fast-paced environment
- Proficiency with claims management systems and Microsoft Office
Preferred Qualifications
- Extensive prior end to end PIP claims handling experience
- Experience with SIU referrals and fraud investigation
Key Competencies
- Attention to detail and regulatory compliance
- Critical thinking and problem-solving
- Customer-focused mindset
- Time management and organizational skills
- Leadership and mentorship ability
Work Environment
- Remote
- Standard business hours with occasional extended hours as needed
Benefits: Medical, Dental, Vision, HSA*, PTO, 401k, Company observed Holidays Individuals seeking employment at Aspire General Insurance Services LLC are considered without regards to race, color, religion, national origin, age, sex, marital status, ancestry, physical or mental disability, veteran status, gender identity, or sexual orientation in accordance with federal and state Equal Employment Opportunity/Affirmative Action record keeping, reporting, and other legal requirements.
- Depending on plan selected
Compensation may vary based on several factors, including candidate's individual skills, relevant work experience, location, etc. Apply tot his job Apply To this Job