PIP Rep

NJM Insurance Group•Parsippany-Troy Hills, NJ

3d•Onsite

About The Position

NJM is a leading provider of workers' compensation, automobile and homeowners insurance in New Jersey, with a nationally ranked reputation for outstanding customer service and a history spanning more than a century. The company has recently expanded into other states. NJM operates for the sole benefit of its policyholders and is committed to maintaining the highest levels of service. The Parsippany Medical Services Administration team is seeking a Personal Injury Protection Claims Representative (PIP Rep). This role reports to the designated PIP Supervisor and is responsible and accountable for conducting complete and thorough investigations on assigned claims and medically managing those claims through their life cycle. This exciting opportunity is great for someone who is highly organized and enjoys working in a fast-paced environment.

Requirements

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
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

Nice To Haves

Bachelor’s degree preferred

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.
Concise 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).