PIP Representative

New Jersey Manufacturers•Parsippany, NJ

4d•Hybrid

About The Position

NJM's Parsippany Medical Services Administration team is seeking a Personal Injury Protection Claims Representative (official NJM title: PIP Rep I/II/Sr.). Reporting to the designated PIP Supervisor, this 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 arrangement available after training is complete: three days in the office and two days remote. The position may be filled at Level I, II, or Senior, with level and compensation based on skills, direct experience, and credentials. The listed salary ranges are $51,120.55–$67,542.80 for Level I, $61,256.00–$93,254.20 for Level II, and $81,123.90–$107,157.70 for Senior. The posting also lists a pay range of $61,256–$77,255 and states that salary is commensurate with experience and credentials.

Requirements

Excellent verbal and written communication skills.
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 in the required qualifications; the role may be filled at different levels with stated direct-experience ranges of 0–3 years for Level I, 3–6 years for Level II, and 6–8 years for Senior.
Ability to apply regulatory requirements appropriately by state.
Thorough understanding of processes and regulatory knowledge associated with arbitration and subrogation.

Nice To Haves

Bachelor’s degree preferred.

Responsibilities

Review PIP coverages, 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 make appropriate referrals.
Conduct claim activities in compliance with state and company regulations and guidelines.
Render final coverage determinations within regulatory guidelines.
Maintain written and verbal communication with involved parties during the claim, providing relevant determinations and information.
Concisely and accurately document all actions taken throughout the claim.
Manage requests for medical treatment, durable medical equipment, PIP Care Paths, medical guidelines and policies, internal or external peer reviews, and independent medical examinations when 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 life of the claim and adjust reserves when needed.
Calculate and issue non-medical benefits, including wages, essential services, and death benefits.