PIP- Personal Injury Protection Rep (I/II/ Sr.)

About the role

Become a member of our team and you’ll be part of a company who operates for the sole benefit of its policyholders and is committed to maintaining the highest levels of service. Team members are offered a competitive compensation package and benefits including: a 401k plan, health coverage, a generous paid time off plan, and much more!

Job Responsibilities

• Review PIP coverages and/or identify coverage issues and investigate and analyze the loss event, the injury and other relevant information to make a determination as to coverage and course of action.
• Evaluate claims for fraud indicators and potential underwriting issues and process appropriate referrals.
• Conduct activities in compliance with state and company regulations and guidelines.
• Render final coverage determination within regulatory guidelines.
• Maintain communication with involved parties during the course of the claim, via written and/or verbal communication, to provide relevant determinations and/or information.
• Concisely and accurately document all actions taken throughout the course of the claim.
• Manage all requests for medical treatment, durable medical equipment, PIP Care Paths, medical guidelines and policies, internal and/or external peer reviews and/or IMEs, when required, communicate determinations to appropriate parties within 3 business days.
• Request necessary Independent Medical Examinations and render determinations for additional treatment or termination benefits.
• Establish adequate medical and non-medical benefits reserves for the life of the claim and adjust reserves, if needed.
• Calculate and issue non-medical benefits (wages, essential services, death benefits).

Required Qualifications And Experience

• Excellent verbal and written communication skills, knowledge of Microsoft suite
• Strong interpersonal and customer service skills
• Good organizational, time-management, and data entry skills
• Decision-making and multi-tasking capabilities
• Bachelor’s degree preferred
• 3-5 years of claims handling
• Able to apply regulatory requirements appropriately by state
• Thorough understanding of all process and regulatory knowledge associated with arbitration and subrogation

What is it like to work at NJM?

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Pay and Benefits

Compensation: Salary is commensurate with experience and credentials. Pay Range: $51,121-$59,332

Eligible full-time employees receive a competitive Total Rewards package, including but not limited to a 401(k) with employer match up to 8% and additional service-based contributions, Health, Dental, and Vision insurance, Life and Disability coverage, generous PTO, Paid Sick Leave, and paid parental leave in addition to state-mandated leave. Employees may also be eligible for discretionary bonuses.