Claims Representative, Auto – PIP

This is a fully remote position, open to applicants in Florida, +5 more states.

📋 Description

• Assess auto claims that involve individuals who have sustained injuries.

• Oversee first-party medical treatments to verify eligibility for personal injury protection and/or medical payment benefits.

• Analyze claims to understand the specifics of the medical loss and clarify coverage details.

• Investigate policy contracts and interpret the language to make informed coverage decisions related to first-party medical benefits.

• Evaluate medical treatments, scrutinize medical bills, and initiate or oversee potential fraud investigations.

• Analyze medical records to understand injuries and manage ongoing treatment for claimants.

• Recognize claim exposures and set or modify reserves on assigned cases.

• Ensure that claim files are thoroughly documented and accurately coded in accordance with the policy.

• Accurately document all claim activities and workflows throughout the claim's lifecycle in compliance with standard operating procedures.

• Communicate effectively and promptly with clients, claimants, healthcare providers, legal offices, and vendors.

• Negotiate claim settlements and authorize payments within designated limits.

• Execute additional responsibilities as required.

⛳️ Requirements

• A bachelor's degree from an accredited institution is preferred.

• State adjuster licenses are mandatory.

• A minimum of three (3) years of experience in Personal Injury Protection (PIP), medical payments, and/or workers' compensation, or an equivalent combination of education and experience.

• Understanding of medical terminology and the appropriate application of deductibles and limits.

• Familiarity with Bodily Injury (BI)/Casualty adjusting practices.

• Strong oral and written communication skills.

• Proficient in PC usage, including Microsoft Office applications.

• Required organizational skills.

• Competence in keyboarding.

• Ability to hear, see, and communicate effectively.

• Strong critical thinking abilities.

• Excellent judgment and discretion.

• Capability to meet deadlines effectively.

🏝️ Benefits

• Flexible work schedule.

• Referral incentive program.

• Opportunities for career development and promotions.

• Medical, dental, and vision insurance.

• 401K enrollment from day one.

• 401K matching available.

• Paid Time Off (PTO).

• Disability and life insurance options.

• Employee assistance programs.

• Flexible spending or health savings accounts.

• Additional voluntary benefits available.