PIP Claims Representative I

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. We are looking for talent with and without prior experience in the insurance industry.

Schedule: Monday through Friday, with work from home opportunities after training.

PIP Claims Representative:

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.

• 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 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.
• 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.
• 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.

• 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.
• Bachelor's degree preferred.
• 3-5 years of claims handling experience preferred.

Salary Range: $48,000 - $56,000 annually. Salary is commensurate with experience and credentials.

This role may be filled at a Level II or Senior level based on skills, experience and credentials.

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.