PIP Claims Representative I

<strong>Personal, compassionate service is what we&rsquo;re known for at NJM. We seek the best and brightest to help our customers when they need us most. As part of the NJM team, you'll not only enjoy some of the best benefits in the industry, you'll also be joining a company that's committed to professional development, diversity and innovative thinking.</strong><br /><br /><strong>What is it like to work at NJM?&nbsp; Click <a href="https://www.youtube.com/watch?v=6XVn3U0XK-0&amp;feature=emb_logo" target="_blank" title="Video" rel="noopener noreferrer">here</a> to see!<br /><br />If you don't see the position you are looking for, apply <a href="https://njm.wd1.myworkdayjobs.com/en-US/njm/introduceYourself" target="_blank" title="Introduce Yourself" rel="noopener noreferrer">here</a>.<br /></strong>


NJM Insurance

<p><strong>This isn&rsquo;t just insurance.&nbsp; It&rsquo;s NJM.</strong></p> <p>When you join the NJM family, you&rsquo;ll work with talented people who care about doing the right thing by our policyholders as well as each other. You&rsquo;ll be part of a financially strong and stable company that has flourished on relationships, integrity and service for more than a century. NJM is a special place where you can propel your career, help others and make friends &ndash; all at the same time.&nbsp;</p> <p>NJM is proud to offer our employees continuous learning options, outstanding benefits, access to wellness programs, and a wide range of opportunities to give back to the communities we are privileged to serve.&nbsp;</p> <p>Leading, independent consumer publications repeatedly recognize our commitment to customer and claims satisfaction. In addition, NJM has been named to the Forbes list of the Best Employers in New Jersey three years in a row, based on feedback directly from our employees.</p> https://www.njm.com/about/careers

keywords: position summary,analysis,medical,management,compliance,quality assurance,skills,education & experience

Full time

$48,000 - $56,000 annually

Overview: <p>NJM Insurance Group (NJM), a top-rated insurance company, is looking for a Personal Injury Protection Representative who has excellent communication skills as well as strong organizational and time management skills. &nbsp;We are looking for talent with and without prior experience in the insurance industry.</p> <p><strong>Schedule:</strong> Monday through Friday, with work from home opportunities after training.&nbsp;</p> <p><strong>PIP Claims Representative:</strong></p> <p>Reporting to the immediate designated PIP Supervisor, the PIP claims representative is responsible and accountable for conducting complete and thorough investigation on assigned claims and medically managing those claims throughout their life cycle.</p>
Responsibilities: <ul> <li>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.</li> <li>Evaluate claims for fraud indicators and potential underwriting issues and process appropriate referrals. Conduct activities in compliance with state and company regulations and guidelines.&nbsp;</li> <li>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.</li> <li>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.</li> <li>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.</li> <li>Request necessary Independent Medical Examinations and render determinations for additional treatment or termination benefits.</li> <li>Establish adequate medical and non-medical benefits reserves for the life of the claim and adjust reserves, if needed.</li> <li>Calculate and issue non-medical benefits (wages, essential services, death benefits).</li> <li>Demonstrates knowledge in NJ and in other states and is able to apply regulatory requirements appropriately.</li> <li>Understands and applies all process and regulatory knowledge associated with arbitration and subrogation. Effectively utilizes all applications and manages time and responsibilities.&nbsp;</li> </ul>
Requirements: <ul> <li>Excellent verbal and written communication skills, knowledge of Microsoft suite.</li> <li>Strong interpersonal and customer service skills.</li> <li>Good organizational, time-management, and data entry skills.</li> <li>Decision-making and multi-tasking capabilities.</li> <li>Bachelor&rsquo;s degree preferred.</li> <li>3-5 years of claims handling experience preferred.</li> </ul> <p>&nbsp;</p> <p><strong>Salary Range:</strong> $48,000 - $56,000 annually. Salary is commensurate with experience and credentials.</p> <p>This role may be filled at a Level II or Senior level based on skills, experience and credentials.</p> <p>&nbsp;</p> <p>Legal Disclaimer: NJM is proud to be an equal opportunity employer. We are committed to attracting, retaining and promoting a diverse and inclusive workforce that is fully representative of the diversity that exists in the communities in which we do business.</p>