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NJM Insurance Group · 3 months ago

Personal Injury Protection (PIP) Representative (I/II/ Sr.)

NJM - Parsippany

Full-time

Hybrid

New Grad, Entry, Mid, Senior Level

$50K/yr - $58K/yr

0+ years exp

NJM Insurance Group, a top-rated insurance company, is seeking a Personal Injury Protection Representative to manage and evaluate claims related to personal injury protection. The role involves reviewing coverages, determining coverage issues, and maintaining communication with involved parties throughout the claims process.

InsuranceManufacturingTransportation

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