Claims Representative, Auto, PIP

📋 Description

• Assess auto claims involving injured individuals and oversee first-party medical treatment to establish eligibility under personal injury protection and/or medical payment benefits.

• Examine claims to ascertain the specifics of the medical loss and provide a clear explanation of coverage.

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

• Evaluate medical treatment, scrutinize medical bills, and initiate or review potential fraud investigations.

• Analyze medical records related to injuries and address ongoing treatment requirements for claimants.

• Recognize claim exposures and set reserves appropriately on assigned files.

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

• Record all claim activities precisely throughout the duration of the claim.

• Maintain effective communication with clients, claimants, medical providers, and vendors.

• Negotiate claim resolutions and authorize payments within designated limits.

⛳️ 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 payment, and/or workers' compensation, or an equivalent combination of education and experience.

• Nursing experience is advantageous.

• Proficient knowledge of medical terminology and the appropriate application of deductibles and limits.

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

• Strong organizational skills are necessary.

🏝️ Benefits

• Medical

• Dental

• Vision

• 401k and matching

• PTO

• Disability and life insurance

• Employee assistance

• Flexible spending or health savings account

• Additional voluntary benefits