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

Job 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 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).

Required Qualifications and Experience:

• 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

This role may be filled at a level I, II, or Sr.

The starting salary per level based on skills, direct experience, and credentials:

Level I (0- 3 years of direct experience) : $51,120.55 - $67,542.80

Level II (3- 6 years of direct experience): $61,256.00 - $93,254.20

Sr Level (6- 8 years of direct experience): $81,123.90 - $107,157.70

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