PIP Representative

NJM Insurance Group•Parsippany-Troy Hills, NJ

7d•$61,256 - $77,255•Hybrid

About The Position

NJM’s Parsippany Medical Services Administration team is hiring a Personal Injury Protection Claims Representative (official NJM title: PIP Rep I/II/Sr.). Reporting to the designated PIP Supervisor, the representative conducts thorough investigations of assigned claims and medically manages them throughout their life cycle. The role is based at NJM’s Parsippany office, with a hybrid schedule available after training: three days in the office and two days remote. The position may be filled at Level I, II, or Senior. Starting salary ranges by level are $51,120.55–$67,542.80 for Level I (0–3 years of direct experience), $61,256–$93,254.20 for Level II (3–6 years), and $81,123.90–$107,157.70 for Senior (6–8 years). Salary is commensurate with experience and credentials. The posting also lists a pay range of $61,256–$77,255. Eligible full-time employees receive a total rewards package that includes a 401(k) with employer match up to 8% and additional service-based contributions; health, dental, vision, 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. NJM is an equal opportunity employer committed to attracting, retaining, and promoting a diverse and inclusive workforce.

Requirements

Excellent verbal and written communication skills and knowledge of the Microsoft suite.
Strong interpersonal and customer service skills.
Good organizational, time-management, and data-entry skills.
Decision-making and multitasking capabilities.
Three to five years of claims-handling experience is listed as a qualification; the role may be filled at levels with differing direct-experience ranges.
Ability to apply regulatory requirements appropriately by state.
Thorough understanding of processes and regulatory requirements associated with arbitration and subrogation.

Nice To Haves

Bachelor’s degree preferred.

Responsibilities

Review PIP coverage, identify coverage issues, and investigate and analyze the loss event, injury, and other relevant information to determine coverage and the appropriate course of action.
Evaluate claims for fraud indicators and potential underwriting issues, and process appropriate referrals.
Conduct claim activities in compliance with applicable state and company regulations and guidelines.
Make final coverage determinations within regulatory guidelines.
Communicate with involved parties throughout the claim by written and/or verbal means to provide relevant determinations and information.
Accurately and concisely document all actions taken during the claim.
Manage requests for medical treatment and durable medical equipment, and apply PIP Care Paths, medical guidelines and policies, peer reviews, and IMEs as required.
Communicate determinations to appropriate parties within three business days.
Request necessary Independent Medical Examinations and determine whether additional treatment is approved or benefits are terminated.
Establish adequate medical and non-medical benefit reserves for the claim and adjust reserves as needed.
Calculate and issue non-medical benefits, including wages, essential services, and death benefits.