Claims Representative, Auto | PIP

About the Role

To evaluate auto claims involving injured parties and manage first party medical treatment to determine eligibility under personal injury protection and/or medical payment benefits.

Responsibilities

• Reviews claims to determine the nature of the medical loss and provides explanation of coverage.
• Researches policy contract and interprets policy language to make coverage decisions based on 1st party medical coverage.
• Assesses medical treatment, evaluates medical bills, and initiates or reviews potential fraud investigations.
• Interprets medical records regarding injuries and addresses ongoing and continuous treatment for claimant.
• Identifies claim exposures and establishes reserves or adjust reserves accordingly on assigned files.
• Ensures claim files are properly documented and correctly coded based on the policy.
• Documents all claim activity and workflow accurately throughout the life of the claim in accordance with standard operating procedures.
• Provides effective and timely communication to client, claimants, medical providers, attorney offices, and vendors.
• Negotiates resolution of claims and makes payments within authority.
• Performs other duties as assigned.

Qualifications

• Education & Licensing: Bachelor's degree from an accredited college or university preferred. State adjuster licenses required.
• Experience: Three (3) years of Personal Injury Protection (PIP), medical payment and/or workers compensation or equivalent combination of education and experience. Nursing experience a plus.
• Skills: Knowledge of medical terminology and appropriate application of deductibles and limits, familiarity with Bodily Injury (BI)/Casualty adjusting, oral and written communication skills, PC literate (including Microsoft Office products), and organizational skills required.

Work Environment Requirements

• Physical: Computer keyboarding.
• Auditory/Visual: Hearing, vision, and talking.
• Mental: Clear and conceptual thinking ability; excellent judgement and discretion; ability to meet deadlines.

Benefits

• Flexible work schedule.
• Referral incentive program.
• Career development and promotional growth opportunities.
• Comprehensive benefits offering including medical, dental, vision, and 401K (with matching from day one).
• Paid time off (PTO).
• Disability and life insurance.
• Employee assistance program.
• Flexible spending or health savings account.
• Additional voluntary benefits.

Pay

For the jurisdiction noted in this job posting, the range of starting pay for this role is $60,000–$65,000.