Commercial Auto Claims Representative – PIP

This is a fully remote position, open to applicants in United States.

📋 Description

• Conduct investigations into PIP and Medical Payments claims to confirm coverage, eligibility, benefits, limits, deductibles, exclusions, and coordination-of-benefits requirements.

• Analyze policy language and apply state-specific PIP, no-fault, and MedPay statutes, regulations, fee schedules, and claims-processing timelines.

• Gather and assess accident details, medical records, itemized invoices, treatment notes, wage documentation, and other relevant claim materials.

• Review medical invoices for coding accuracy, duplication, relatedness, reasonableness, necessity, and applicable fee-schedule or contractual adjustments.

• Assess and process covered medical expenses, wage-loss benefits, replacement services, and other PIP benefits.

• Maintain precise benefit payment ledgers and track remaining limits, deductibles, offsets, and exhaustion of benefits.

• Engage with insured individuals, claimants, medical providers, attorneys, billing representatives, and internal partners regarding claim updates and benefit determinations.

• Elevate disputed treatments, suspected fraud, coverage issues, potential overpayments, provider disagreements, and matters needing legal or supervisory review.

• Draft requests for information, explanations of benefits, payment notifications, and coverage or benefit decisions.

• Keep timely diaries, well-organized claim files, payment justifications, and ensure compliance with claim-handling protocols and state regulations.

• Oversee active claim inventory while fulfilling quality, timeliness, and customer-service standards.

• Collaborate with bodily injury, liability, litigation, SIU, and vendor teams as necessary.

• Obtain and uphold required state adjuster licenses.

⛳️ Requirements

• A minimum of 3 years of experience in auto claims, particularly in PIP and/or Medical Payments claim handling.

• Preference for multi-state PIP experience.

• Proficient understanding of no-fault/PIP and MedPay coverage, medical terminology, medical billing, benefit limits, fee schedules, and state-specific claim deadlines.

• Capability to interpret insurance policy language, review medical documentation, assess payable benefits, and convey decisions accurately.

• Excellent written and verbal communication skills, including professional correspondence and interactions with providers and attorneys.

• Strong organizational, analytical, time-management, and computer skills, with the capability to prioritize and handle a busy workload.

• Self-driven and able to work independently in a remote office setting with suitable supervision and escalation when necessary.

• Ability to adapt swiftly to company claim systems, procedures, and evolving priorities.

• Bachelor’s degree preferred; equivalent relevant claims experience will be considered.

• Insurance industry designation is a plus.

• Willingness to travel for company or claim-related events if required.

• Obtain and maintain necessary state adjuster licenses.

🏝️ Benefits

• Exceptional benefits package.

• Competitive salary.

• Remote office environment / fully remote position.

• Potential for regular full-time employment based on business needs and individual performance.

• Opportunity to travel for company or claim-related events if required.