Medical Claims Adjuster II Based in Parsippany (Jurisdictions: CT & OH)

<strong>Personal, compassionate service is what we'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><a href="https://www.youtube.com/watch?v=6XVn3U0XK-0&amp;feature=emb_logo" target="_blank" rel="noopener noreferrer">What is it like to work at NJM?&nbsp; Click here to see!</a></strong>

Parsippany, NJ

NJM Insurance Group

<h3><strong>Come Grow with Us!<br /><br />For more than a century, our policyholders have trusted us to serve them in their times of need. For just as long, we have supported our employees by providing a competitive compensation package and opportunities for growth. If you are looking to be part of something special and make a difference each day, we invite you to come grow with us. There's never been a better time to join the NJM family.&nbsp;</strong><br /><br /><strong>This isn't just insurance.&nbsp; It's NJM.</strong></h3> <p class="p1"><strong><br /><a href="https://phh.tbe.taleo.net/phh02/ats/careers/v2/searchResults?org=NJM3&amp;cws=47" target="_blank" title="NJM Insurance" rel="noopener noreferrer">If you don't see the job you're looking for below, please click&nbsp;</a></strong><a href="https://phh.tbe.taleo.net/phh02/ats/careers/v2/searchResults?org=NJM3&amp;cws=47" target="_blank" title="NJM Insurance" rel="noopener noreferrer"><span class="s1"><strong>here</strong></span><strong>&nbsp;to create a search agent, or log in to check the status of your previous application.</strong>&nbsp;</a></p> <p class="p2">&nbsp;</p> https://www.njm.com/about/careers

keywords: teamwork,medical,environment,reporting,analysis,medical,management,compliance,communication,reporting,skills,organization,degree,communication,experience

Full Time

Overview: <p>Become a member of our team and you&rsquo;ll be part of company who operates for the sole benefit of its policyholders and is committed to maintaining the highest levels of service.&nbsp; Team members are offered a competitive compensation package and benefits including: a 401k plan, health coverage, a generous paid time off plan, and much more!&nbsp; What is it like to work at NJM?&nbsp; Click here to see!&nbsp;</p> <p>Our Parsippany Medical Services Administration team is in search of a PIP Claims Representative with 3-5 years of multi-state claims handling experience (CT, OH strongly preferred).&nbsp; Reporting to the 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 through their life cycle.&nbsp; This exciting opportunity is great for someone who is highly organized and enjoys working in a fast-paced environment.</p>
Responsibilities: <ul> <li>Reporting to the immediate 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; &nbsp;</li> </ul> <p><strong>To accomplish this, the PIP Claims Representative:</strong></p> <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&nbsp;&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.&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> <li>Demonstrates knowledge in NJ and in other states and is able to apply regulatory requirements appropriately.</li> <li>Understands and applies all processes and regulatory knowledge associated with arbitration and subrogation. Effectively utilizes all applications and manages time and responsibilities.&nbsp;&nbsp;</li> </ul> <div id="gtx-trans" style="position: absolute; left: -116px; top: 26px;">&nbsp;</div>
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> <div id="gtx-trans" style="position: absolute; left: -143px; top: 26px;">&nbsp;</div>