Reporting to the immediate designated PIP Supervisor, the PIP claims representative is responsible and accountable for conducting complete and thorough investigations on assigned claims and medically managing those claims through their life cycle.
Schedule: Monday through Friday (8:45AM- 5PM)
Hybrid: 3 days in office, 2 days remote once training is completed
Essential Duties and Responsibilities:
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.
Evaluate claims for fraud indicators and potential underwriting issues and process appropriate referrals. 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.
Maintain communication with involved parties during 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.
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 three business days.
Request necessary Independent Medical Examinations and render determinations for additional treatment or termination benefits.
Establish adequate medical and non-medical benefits reserves for the life of the claim and adjust reserves, if needed.
Calculate and issue non-medical benefits (wages, essential services, death benefits).
Demonstrates knowledge in NJ and in other states and is able to apply regulatory requirements appropriately.
Understands and applies all process and regulatory knowledge associated with arbitration and subrogation. Effectively utilizes all applications and manages time and responsibilities.
Required Qualifications:
Excellent verbal and written communication skills, knowledge of Microsoft suite
Strong interpersonal and customer service skills
Good organizational, time-management, and data entry skills
Decision-making and multi-tasking capabilities
Preferred Qualifications:
Bachelor’s degree
3-5 years of claims handling experience
5-7 years of claims handling experience
This role may be filled at a level I, II, or Sr.
The starting salary per level based on skills, direct experience, and credentials:
Level I (0- 3 years of direct experience) : $49,871 - $57,880
Level II (3- 6 years of direct experience): $59,744 - $75,361
Sr Level (6- 8 years of direct experience): $79,129- $91,833
Benefits Offered:
Medical Insurance (Blue Cross Blue Shield)
Dental Insurance (Delta Dental)
Vision (Delta Vision/ VSP)
Flexible Spending Account
Discounts on NJM auto insurance
Tuition reimbursement
Life insurance
Plus, additional company discounts for items like travel, service, car rental and more!
Compensation: Salary is commensurate with experience and credentials.
Pay Range: $49,871-$57,881Eligible full-time employees receive a competitive Total Rewards package, including but not limited to a 401(k) with employer match up to 8% and additional service-based contributions, Health, Dental, and Vision insurance, Life and Disability coverage, generous PTO, Paid Sick Leave, and paid parental leave in addition to state-mandated leave. Employees may also be eligible for discretionary bonuses.
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.