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Claims Representative - PIP II

Employer
New Jersey Manufacturers Insurance Company
Location
Parsippany, New Jersey
Salary
Competitive comp package/ benefits including: a 401k /health coverage, generous PTO and much more!
Closing date
Oct 2, 2020

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Job Details

Overview

There’s never been a better time to join NJM!  With a nationally ranked reputation for outstanding customer service and a history that spans more than a century, NJM is a leading provider of worker’s compensation, automobile and homeowners insurance in New Jersey .  It is an exciting time to join NJM as we have just expanded into other states.
  
Become a member of our team and you’ll be part of company who operates for the sole benefit of its policyholders and is committed to maintaining the highest levels of service.  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!

Our Parsippany Medical Services Administration team is in search of a PIP Claims Representative. 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.  This exciting opportunity is great for someone who is highly organized and enjoys working in a fast paced environment.

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 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).

Requirements

Required Skills & Experience:

  • 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 with out of state experience preferred  
  • Able to apply regulatory requirements appropriately by state  
  • Thorough understanding of all process and regulatory knowledge associated with arbitration and subrogation

 

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.

Company

New Jersey Manufacturers Insurance Company (NJM), a property and casualty insurance company, has earned a reputation for superior service and prompt, fair handling of claims. NJM customarily earns high marks in published surveys, particularly regarding customer and claims service in auto insurance. NJM operates in a mutual fashion for the exclusive benefit of policyholders. NJM is cost-effective and conservative — staff is paid by salary with no commissions, and the Company does not advertise broadly to help earn profits for stockholders. Dividends have been paid to policyholders each year since 1918, a cumulative total of more than $5.0 billion. 

Company info
Website
Telephone
609-883-1300
Location
301 Sullivan Way
West Trenton
New Jersey
08628
US

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