Claim Rep Sr - SIU, Casualty - Major Case; Hybrid or Remote

Claim Rep Sr - SIU, Casualty - Major Case (Hybrid or Remote)

Date:
Sep 9, 2026

Location:

Webster or Remote, MA, US

Company: MAPFRE

Compensation and level will be commensurate with experience.

Come join a team where your investigative expertise and knowledge make a real impact. We are looking for an experienced SIU Major Case Adjuster for investigation, evaluation, and resolution of complex, high-severity suspicious personal injury claims involving potential fraud, organized schemes, material misrepresentation, and/or significant financial exposure. This role primarily handles Massachusetts personal injury claims, including Bodily Injury, Personal Injury Protection (PIP), Uninsured/Underinsured Motorist (UM/UIM), and related fraud investigations, with occasional exposure to physical damage claims.

The position requires expert knowledge of Massachusetts insurance laws including Code of MA Regulations (CMRs),PIP benefits, CPT coding analysis, AIS bill review systems,provider fraud investigations, and claim handling practices.

This role offers the opportunity to work independently, collaborate with legal and investigative partners, and play a critical role in protecting both our customers and the organization through thoughtful, strategic claim handling.

• Manage a diverse caseload of casualty claims, including Bodily Injury, PIP/No-Fault, Med Pay, UM/UIM, and suspected fraud-related matters.
• Conduct detailed investigations through recorded statements, scene reviews, witness interviews, database research, and collaboration with field investigators.
• Analyze policy coverage, liability exposures, damages, medical records, treatment plans, billing documentation and provider activity to ensure compliance with CMRs, as well as applicable statutes across multiple jurisdictions.
• Evaluate medical treatment, wage loss claims, and other damages using a variety of investigative resources including the utilization of CPT, HCPCS, and ICD coding knowledge to evaluate treatment and billing practices.
• Collaborate with the Massachusetts Insurance Fraud Bureau, law enforcement, defense counsel, and regulatory partners.
• Actively engage in ongoing professional development by attending industry conferences, participating in virtual and in-person training programs, and completing relevant webinars and educational opportunities.
• Prepare investigative reports, referrals, and prosecution packages as appropriate.
• Manage litigation-related investigations and support depositions, EUOs, arbitrations, mediations, and trials.
• Develop effective claim strategies that lead to timely and fair resolutions.
• Negotiate settlements through phone conferences, mediations, arbitrations, and face-to-face discussions.
• Maintain accurate reserves and manage claim expenses responsibly.
• Partner with experts, medical professionals, and vendors to support claim evaluations and investigations.

• Direct and oversee defense counsel on litigated claims.
• Participate in depositions, examinations under oath, mediations, arbitrations, and trial-related activities.
• Prepare responses to regulatory inquiries, consumer complaints, and Department of Insurance matters.
• Ensure compliance with state regulations and company claim-handling standards.

• Serve as a mentor and resource for less experienced adjusters.
• Share best practices and contribute to training initiatives.
• Recommend process improvements that enhance efficiency and customer experience.
• Represent the organization with professionalism in all internal and external interactions.

• Bachelor's degree or equivalent combination of education and related experience.
• 2+ years of casualty claims…