Senior PIP Adjuster; Texas Claims

Senior PIP Adjuster (Texas Claims) Position Summary

Looking for a candidate with extensive Texas Personal Injury Protection (PIP) experience. The Senior PIP Adjuster is responsible for the prompt, accurate, and compliant handling of complex PIP claims in 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. The ideal candidate will assist with standing up our PIP department.

Medical Payments (MP) experience in other states is a plus.

• Investigate, evaluate, and adjust PIP claims in accordance with Texas laws and company guidelines.
• Obtain 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 escape 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.

• 5+ years of PIP claims handling experience, with a 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.
• 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.

• Extensive prior end‑to‑end PIP claims handling experience.
• Experience with SIU referrals and fraud investigation.
• Attention to detail and regulatory compliance.
• Critical thinking and problem‑solving.
• Customer‑focused mindset.
• Time management and organizational skills.
• Leadership and mentorship ability.
• Remote work capability.
• Standard business hours with occasional extended hours as needed.

• Medical, Dental, Vision, HSA*, PTO, 401(k)
• Company observed holidays

Individuals seeking employment at Aspire General Insurance Services LLC are considered without regard 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.

Compensation may vary based on several factors, including candidate's individual skills, relevant work experience, and location.