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

New Jersey Manufacturers • Parsippany, NJ

13d • Hybrid

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.
• Maintain communication with involved parties during 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 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).
• Demonstrates knowledge in NJ and in other states and is able to apply regulatory requirements appropriately.
• Understands and applies all process and regulatory knowledge associated with arbitration and subrogation.
• Effectively utilizes all applications and manages 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
• Plus, additional company discounts for items like travel, service, car rental and more!
• Eligible full-time employees receive a competitive Total Rewards package, including but not limited to a 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, and paid parental leave in addition to state-mandated leave. Employees may also be eligible for 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