Claims Specialist l

First Student • Cincinnati, OH • 3h ago

First for a reason:

At First Student, we are a family of 60,000+ employees who take pride in safely transporting more than 5 million students and passengers to and from their destinations each day! Our family of brands include Transco, Total Transportation, Maggies Paratransit, and GVC II. Our employees are at the forefront of safety and innovation; they create and implement the most advanced training and technology the transportation industry has to offer.

This hybrid position is responsible for managing both bodily injury (commercial auto and general) and Personal Injury Protection (PIP) claims. The role requires 50% of time dedicated to traditional liability claims handling and 50% to PIP claims examination. The ideal candidate will proactively investigate, evaluate, and resolve claims in accordance with best practices, ensuring compliance with legal and regulatory requirements.

Key Responsibilities

Liability Claims (50%)

Establish 24-hour contact and maintain communication with all stakeholders throughout the claim lifecycle.

Investigate claims by gathering information, conducting interviews, taking statements, and reviewing reports and bills.

Evaluate and determine appropriate reserving levels in compliance with claim guidelines.

Select and direct external service providers (e.g., attorneys, independent adjusters, experts).

Identify and pursue subrogation, contribution, and SIU opportunities.

Negotiate and resolve non-complex claims, including litigated matters, within authority limits.

Refer cases outside of authority level with appropriate documentation.

Support the development and refinement of claims management procedures.

PIP Claims Examination (50%)

Review and analyze medical documentation and billing to determine coverage and medical necessity.

Apply knowledge of state-specific PIP laws and regulations to ensure accurate claim adjudication.

Communicate with medical providers, claimants, and attorneys to gather necessary documentation.

Identify potential fraud indicators and refer to SIU when appropriate.

Maintain accurate and timely documentation in the claim system.

Ensure compliance with statutory deadlines and internal service standards.

Qualifications

Bachelor's degree with a minimum of 7 years of experience in the claims, or high school diploma with 8 years of relevant experience.

Extensive experience in bodily injury and PIP claims.

Experience handling litigated files and directing defense counsel.

Strong knowledge of PIP regulations and medical billing practices.

Licensure as required by respective state(s).

Professional certifications such as CPCU, AIC, or SCLA are a plus.

Excellent negotiation, communication, and customer service skills.

Strong organizational and multitasking abilities

In the state of Washington, all technician and driving positions, including but not limited to van drivers and any other position requiring employees to drive a company-owned vehicle, are considered safety-sensitive and are therefore subject to drug and alcohol testing, including cannabis.

All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability or veteran status. First is also committed to providing a drug-free workplace. First will consider for employment qualified applicants with criminal histories consistent with the requirements of the San Francisco Fair Chance Ordinance, Los Angeles Fair Chance Ordinance, and any other fair chance law. Philadelphia's Fair Criminal Record Screening Standards Ordinance Poster is at this link or upon request https://www.phila.gov/media/20210423160847/Fair-Chance-Hiring-law-poster.pdf .

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