Claim Representative I - PIP Unit

Overview

The Claim Representative-PIP Unit handles no-fault claims from all claim offices within the state of Kentucky to ensure efficient and effective processing of Personal Injury Protection (PIP) benefits.

Responsibilities

• Accept assignment of PIP claims from claim adjusters.
• Monitor continuing eligibility of PIP claimants.
• Receive, investigate, coordinate, and pay appropriate PIP benefits promptly according to statute requirements.
• Maintain proper reserves.
• Process incoming and outgoing mail regarding the PIP Unit.
• Create and type correspondence and issue form letters to investigate, resolve, and respond to questions relating to PIP benefits.
• Receive telephone and personal inquiries relating to PIP files by policyholders, customers, attorneys, and medical providers, assisting where appropriate or referring to other staff if necessary.
• Assure high customer satisfaction levels through professionalism, integrity, fairness, and promptness.
• Assist and cooperate with all company personnel.
• Maintain PIP files to comply with statute requirements.
• Monitor the claim inventory report to ensure proper closure of files.
• Pursue professional development.
• Report claims as required by the claims manual or by the district claims manager.
• Serve as a catastrophe team member or assist in other claim offices or locations as required.
• Regular, predictable attendance as an employee has to physically be in the office.
• This list of essential functions is non-exhaustive and may be supplemented as necessary.

Other Responsibilities

• Establish companion PIP work file.
• Secure appropriate PIP documents, i.e., medical reports, wage verifications, and PIP applications.
• Obtain initial claim payment authority on each claimant from claim adjusters.
• Diary all companion claim files to comply with statute requirements.
• Furnish a copy of the PIP application, medical reports, and wage verification to claim adjusters as requested.
• Receive, investigate, and pay medical bills, wage loss benefits, survivor's economic benefits, replacement service benefits, and funeral expense benefits.
• Maintain appropriate reserves for both basic and added reparation benefits.
• Perform claim file maintenance transactions via terminal entry.
• Receive and review loss reports regularly from agents, claim adjusters, and senior adjusters.
• Establish claim files using data from loss reports.
• Type letters and forms required to properly investigate and document payment of no-fault benefits.
• Transmit recoveries to the Accounting Department on a timely basis.
• Report claims as required by the Claim Manual or by the District Claims Manager.
• Promptly respond to complaints as requested.
• Report immediately the receipt of all summonses to the PIP Unit Supervisor and handle as directed.
• Review claim inventory reports monthly and make needed adjustments.
• Make corrections on claim files as recommended by the PIP Unit Supervisor or Team Lead following review.
• Document claim files to support actions taken. (See claim manual)
• May be called upon to handle first-party claims and non-disputed liability claims.
• May be called upon to assist in the evaluation of inventory sheets for property loss claims.
• Attend and participate in company meetings, seminars, and other company-sponsored educational activities at the request of the company.
• May work a late Friday on a rotating basis to provide customer service to claims offices, agents, and providers.
• Attain the Certificate in General Insurance from the Insurance Institute of America.
• Maintain current knowledge of policy contracts and statutes.

Job Specifications

• Physical demands: Normal vision/hearing with or without correction; Sitting.
• Mental demands: Analytic reasoning; Prolonged concentration.
• Environmental factors: Standard office lighting, temperature, and noise.
• Equipment: Keyboard; Telephone; Calculator; Copier/Fax.

Qualifications

• Associate degree or a combination of formal education, training, and experience to acquire knowledge and skills generally equivalent to those possessed by a two-year college graduate. Bachelor's degree preferred.
• Required to obtain an Adjuster License within one year of hire date.
• Previous experience in a claims or insurance office desirable.
• Average typing skill (minimum 35 wpm).
• Knowledge of claims handling procedures and insurance contracts.
• Experience in the use of photocopiers, computer terminals, or word processors and other office equipment.
• Ability to communicate with a high level of skill both orally and in writing.
• Ability to make timely decisions.
• Excellent Human Relations Skills And Self-motivation Required.
• Ability to act confidentially.
• Knowledge of word processing software.