PIP Claims Representative

Job Description

Job Description

Position Summary

The PIP Claims Representative will handle the investigation, evaluation and disposition by settlement, payment, or denial of complex Personal Injury Protection claims.

Ensure that claims are processed within company policies, procedures, regulatory requirements, and the individual's prescribed authority with high standards of performance.

Settlement Authority Level : $0 - $15k (employee threshold individually determined); No First EOB Authority

Essential Functions

• Receive assigned claims, verify coverage, confirm eligibility and determine course of action.
• Complete detailed, thorough claim investigation through telephone and / or written correspondence with subscribers, attorneys, witnesses and any others with information relevant to the claim.
• Analyze information obtained through investigation in order to evaluate the claim, determine PIP eligibility and determine the extent of the injuries and claim exposure.
• Establish and maintain the proper reserves for the exposure.
• Assign medical case managers or other experts to a case when appropriate and arrange for independent medical examinations when necessary to determine medical necessity and causal relationship of treatment.
• Handle incoming calls and correspondence from subscribers, claimants, attorneys and providers regarding questions or problems associated with a claim.
• Document claim files and maintain a diary system for reporting and claim follow-up.
• Handle claims in accordance with CURE's Decision Point Review Plan.
• Work closely with the Special Investigation Unit, Underwriting Department, attorneys, and other members of the Claim Department to ensure that CURE achieves optimum results on all files.
• Manages allocated loss adjustment expense. Employs outside vendors when activities cannot be completed by a staff member and directs the activities of vendors to ensure only necessary work is completed.
• Comply with all conditions outlined in the Unfair Claim Practices Acts.
• Reserve authority ranges from $5,000-$10,000.

Physical Demands (as related to the Essential Functions)

• Frequently lifts or carries files which may weigh up to five pounds each.
• Communicates with customers, medical providers, vendors, technical experts and fellow employees.

Nonessential Functions

• Provide technical assistance and guidance to less experienced personnel.
• Assist with training new hires.
• Handle litigation files from start to finish. Evaluate, settle and negotiate both non-litigated and litigated claims within delegated authority.

Minimum Requirements

• Education : Bachelor's degree or commensurate experience in the insurance industry.
• Years / Type of Experience : A minimum of 2 years PIP claim handling experience or commensurate medical experience. Litigation experience a plus.
• Licenses / Designations : Property and Casualty license a plus.
• Specific Skills : Must have the ability to analyze coverages, liability and damages.
• Knowledge : Strong technical knowledge of the statutes and regulations governing personal injury protection claims. Working practical knowledge of litigation from assignment to discovery and trial.
• Other Required or Preferred Qualifications : Detail oriented with strong written and verbal communication skills. Must be able to work independently as well as possess strong interpersonal skills necessary to contribute as a team player.

Success Factors

• Must be detail oriented, expense conscious, organized and have the ability to handle multiple cases / tasks and meet deadlines.
• Ability to organize, prioritize and manage claim volume.
• Ability to analyze issues, recommend solutions and make decisions with some supervisory guidance.
• Ability to articulate thoughts and issues clearly.

Compensation : $58,240 - $76,960 annually based on experience

Applicants must be authorized to work for ANY employer in the U.S. We are unable to sponsor or take over sponsorship of an employment Visa at this time.