PIP Rep

New Jersey Manufacturers•Parsippany, NJ

1d•Onsite

About The Position

There has never been a better time to join NJM! With a nationally ranked reputation for outstanding customer service and a history that spans more than a century, NJM is a leading provider of workers' compensation, automobile and homeowners insurance in New Jersey. It is an exciting time to join NJM as we have just expanded into other states. Become a member of our team and you’ll be part of 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! Our Parsippany Medical Services Administration team is in search of a Personal Injury Protection Claims Representative (PIP Rep is the official NJM title). Reporting to the designated PIP Supervisor, the PIP claims representative is responsible and accountable for conducting complete and thorough investigation 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
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

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).