Claim Representative I - PIP Unit

Kentucky Farm Bureau Mutual Ins Co•Louisville, KY

1d•Onsite

About The Position

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. This role involves managing PIP claims from assignment to closure, ensuring compliance with statutory requirements, and maintaining high customer satisfaction. The position requires regular, predictable attendance and physical presence in the office.

Requirements

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.
Required to obtain an Adjuster License within one year of hire date.
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.
Normal vision/hearing with or without correction.
Analytic reasoning.
Prolonged concentration.

Nice To Haves

Bachelor’s degree preferred.
Previous experience in a claims or insurance office desirable.

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.
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.
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.
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.