Claims Specialist

Farm Family specializes in farm and ranch protection with a wide range of products including flexible farm packages, business owner policies, commercial package, workers compensation, commercial auto and select personal auto coverage. Farm Family is a leader in serving the Northeast and Mid-Atlantic markets and is pursuing growth across the U.S. The Farm Family entities are wholly-owned subsidiaries of Clearbrook Group Holdings Inc.

Summary:

The Claims Specialist is responsible for the end‑to‑end handling of Personal Injury Protection (PIP) and Medical Payment (Med Pay) claims across numerous jurisdictions, from initial investigation through resolution. Working with a high degree of autonomy, this role focuses on accurate coverage determination, compliance with state and federal regulations, as well as fair and timely claim outcomes.

The Specialist manages moderate to high‑complexity PIP and Med Pay claims and collaborates closely with internal partners, medical providers, vendors, and defense counsel as needed.

This is a 100% in-office position. Candidates must be able to work on-site at a designated company office during standard business hours.

Essential Responsibilities:

• Investigate, evaluate, negotiate, and resolve PIP and Med Pay claims in compliance with state statutes, regulations, and case law
• Handle PIP Arbitrations as necessary
• Confirm coverage, review facts of loss, and assess injuries, treatment and medical necessity
• Review and process medical bills, applying fee schedules, coding standards, and cost‑containment methodologies
• Evaluate claim complexity and exposure; escalate or refer matters appropriately
• Communicate directly with claimants, attorneys, medical providers, and vendors
• Negotiate settlements and ensure proper documentation, releases, and regulatory timeframes
• Identify and address coverage, liability, or fraud indicators when present
• Maintain accurate claim documentation and meet regulatory and internal service standards

Qualifications / Experience Required:

• 4 years of claims experience
• Experience evaluating medical records, treatment plans, and claim disputes
• Active adjuster license and ability to maintain required continuing education
• Strong negotiation, analytical, and written communication skills

Preferred Qualifications:

• Bachelor’s degree in a related field or the equivalent work experience

Salary range is $52122 - $82926