Personal Injury Protection (PIP) Claims Representative

ESSENTIAL DUTIES AND RESPONSIBILITIES

• Review, investigate, and process PIP and/or Medpay claims in accordance with applicable laws and policy provisions.
• Determine coverage eligibility, verify medical necessity, and assess reasonableness of charges.
• Communicate with claimants, medical providers, attorneys, etc. to gather necessary documentation to resolve claims.
• Maintain detailed and accurate claim files and documentation.
• Provide clear and empathetic communication to claimants and stakeholders.
• Address inquiries and resolve issues promptly and professionally.
• Prepare reports and summaries for management as needed.

Qualification Requirements

• H.S. Diploma is required
• Must obtain Adjuster’s license in 6 months
• Customer service experience
• Familiarity with medical terminology & treatment protocols
• Proficient in English written and verbal communication skills
• Possesses strong technical aptitude
• Proficient PC skills
• Good math skills