Personal Injury Protection (PIP) Representative (I/II/ Sr.)

NJM Insurance Group

81d • $49,871 - $57,881

About The Position

NJM Insurance Group (NJM), a top-rated insurance company, is looking for a Personal Injury Protection Representative who has excellent communication skills as well as strong organizational and time management skills. We are looking for talent with and without prior experience in the insurance industry. Schedule: Monday through Friday (8:45AM- 5PM) Position is based out of the NJM- Parsippany Office. Hybrid: 3 days in office, 2 days remote once training is completed.

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.
• High school diploma or GED required.

Nice To Haves

• Bachelor’s degree.
• 3-5 years of claims handling experience.
• 5-7 years of claims handling experience.

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 accurate documentation of 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 three 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).
• Demonstrate knowledge in NJ and in other states and apply regulatory requirements appropriately.
• Understand and apply all process and regulatory knowledge associated with arbitration and subrogation.
• Effectively utilize all applications and manage time and responsibilities.

Benefits

• Medical Insurance (Blue Cross Blue Shield)
• Dental Insurance (Delta Dental)
• Vision (Delta Vision/ VSP)
• Flexible Spending Account
• Discounts on NJM auto insurance
• Tuition reimbursement
• Life insurance
• 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
• Paid parental leave in addition to state-mandated leave
• Discretionary bonuses

What This Job Offers

• Job Type: Full-time
• Career Level: Entry Level
• Education Level: High school or GED
• Number of Employees: 1,001-5,000 employees