PIP Claims Rep II

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Parsippany, NJ

NJM Insurance Group

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keywords: medical,environment,reporting,analysis,medical,management,compliance,communication,establish,skills,degree,communication,experience,knowledge

Full Time

Overview: Our Parsippany Medical Services Administration team is in search of a PIP Claims Representative. Reporting to the designated PIP Supervisor, the PIP claims representative is responsible and accountable for conducting a complete and thorough investigation on assigned claims and medically managing those claims through their life cycle.&nbsp; This exciting opportunity is great for someone who is highly organized and enjoys working in a fast-paced environment.
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.&nbsp; Conduct activities in compliance with state and company regulations and guidelines 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.&nbsp;</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> </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 with out of state experience preferred&nbsp;&nbsp;</li> <li>Able to apply regulatory requirements appropriately by state&nbsp;&nbsp;</li> <li>Thorough understanding of all process and regulatory knowledge associated with arbitration and subrogation</li> </ul>