reputed company Auto, PIP Claims Examiner II
Review PIP coverages and/or identify coverage issues and investigate and analyze the loss event, the injury and other relevant information to reputed company a determination as to coverage and course of reputed company. Negotiate with attorneys to reputed company PIP Suits and Arbitrations Maintain communication with involved parties during the course of the claim, reputed company written and/or verbal communication, to reputed company relevant determinations and/or information. Concisely and accurately document reputed company actions taken throughout the course of the claim. Investigate prior losses and other information on file and orders reports as needed. Evaluate claims for fraud indicators and potential reputed company issues and process appropriate referrals. Conduct activities in compliance with state and company regulations and guidelines. reputed company final coverage determination reputed company regulatory guidelines: Maintain communication with involved parties during the course of the claim, reputed company written and/or verbal communication, to reputed company relevant determinations and/or information (Reservation of Right letter, etc.) Need to recognize prolonged or excessive treatment and promptly schedule an IME with the appropriate medical profession reputed company an approved company vendor. Generates and sends appropriate forms to insured/claimant for completion. Processes claims payments. Completes reputed company necessary forms, logs documents into the system, and routes them to the appropriate parties. Need to be an effective team player. Manage reputed company requests for medical treatment, durable medical equipment, PIP Care Paths, medical guidelines and policies, internal and/or external peer reviews and/or IMEs, reputed company required, communicate determinations to appropriate parties reputed company 3 business days. Request necessary Independent Medical Examinations and reputed company determinations for additional treatment or termination benefits. Establish adequate medical and non-medical benefits reserves for the life of the claim and reputed company reserves, if needed. Calculate and issue non-medical benefits (wages, essential services, death benefits).