Claims Representative, Auto, PIP

This is a fully remote position, open to applicants in Florida, +4 more states.

📋 Description

• Assess automobile claims involving injured individuals and oversee first-party medical treatment to determine eligibility for personal injury protection and/or medical payment benefits.

• Analyze claims to identify the type of medical loss and clarify coverage details.

• Investigate policy contracts and interpret policy language for making coverage determinations.

• Evaluate medical treatment, assess medical bills, and initiate or oversee potential fraud investigations.

• Review medical records concerning injuries and manage ongoing and continuous treatment.

• Recognize claim exposures and set or modify reserves accordingly.

• Ensure that claim files are accurately documented and properly coded.

• Record claim activities and workflows throughout the duration of the claim.

• Engage with clients, claimants, medical providers, legal offices, and vendors.

• Negotiate claim resolutions and authorize payments within designated limits.

• Contribute to the organization’s quality assurance programs.

• Perform additional assigned tasks as needed.

⛳️ Requirements

• Required state adjuster licenses.

• A minimum of three (3) years of experience in Personal Injury Protection (PIP), medical payment, and/or workers compensation, or a comparable combination of education and experience.

• Bachelor's degree from an accredited college or university is preferred.

• Nursing experience is advantageous.

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

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

• Proficient in PC usage, including Microsoft Office applications.

• Exceptional negotiation abilities.

• Capability to meet or surpass Performance Competencies.

• Proficient in working both independently and collaboratively in a team environment.

• Ability to meet deadlines and handle multiple priorities effectively.

• Competent in computer keyboarding; travel may be required.

🏝️ Benefits

• Medical insurance coverage.

• Dental insurance coverage.

• Vision insurance coverage.

• 401k plan with matching contributions.

• Paid Time Off (PTO).

• Disability insurance.

• Life insurance coverage.

• Employee assistance programs.

• Flexible spending or health savings accounts.

• Additional voluntary benefits available.

• Reasonable accommodations provided when applicable and appropriate.