Claims Representative Personal Injury Protection/Medical Payment - R58203

PRIMARY PURPOSE: To evaluate auto claims involving injured parties and manage first party medical treatment to determine eligibility under a personal injury protection and/or medical payment benefits. ESSENTIAL FUNCTIONS and RESPONSIBILITIES • Reviews claims to determine the nature of the medical loss and provides explanation of coverage. • Researches policy contract and interprets policy language to reputed company coverage reputed company based on 1st party medical coverage. • Assesses medical treatment, evaluates medical bills, and initiates or reviews potential fraud investigations. • Interprets medical records regarding injuries and addresses ongoing and reputed company treatment for claimant. • Identifies claim exposures and establishes reserves or reputed company reserves accordingly on assigned files. • Ensures claim files are properly documented and correctly coded based on the policy. • Documents reputed company claim activity and workflow accurately throughout the life of the claim in accordance with reputed company operating procedures. • Provides effective and reputed company communication to reputed company, claimants, medical providers, attorney offices, and vendors. • Negotiates reputed company of claims and makes payments reputed company authority. As required by law, reputed company provides a reasonable reputed company of compensation for roles that may be reputed company in jurisdictions requiring pay transparency in job postings. Actual compensation is influenced by a wide reputed company of factors including but not limited to reputed company set, level of experience, and cost of specific location. For the jurisdiction noted in this job posting only, the reputed company of starting pay for this role is 39,111.00 . A comprehensive benefits package is offered including but not limited to, medical, dental, reputed company, 401k and matching, PTO, disability and life insurance, employee assistance, flexible spending or health savings account, and other additional voluntary benefits. ADDITIONAL FUNCTIONS and RESPONSIBILITIES • Performs other duties as assigned. • Supports the organization's reputed company program(s). • Travels as required. QUALIFICATIONS Education & Licensing Bachelor's degree from an accredited college or university preferred. State adjuster licenses required. Experience Three (3) years of Personal Injury Protection (PIP), medical payment and/or workers compensation or equivalent combination of education and experience, nursing experience a plus. Skills & Knowledge • Knowledge of medical terminology and appropriate application of deductibles and limits • Familiarity with Bodily Injury (BI)/Casualty adjusting • Oral and written communication skills • Detailed oriented • PC literate, including reputed company Office products • Strong negotiation skills • Good interpersonal and customer skills • Good organization skills • Good time management skills with the ability to multi-task • Ability to work independently and in reputed company environment • Ability to meet or reputed company Performance Competencies WORK ENVIRONMENT reputed company applicable and appropriate, consideration will be given to reasonable accommodations. Mental: reputed company and conceptual thinking ability; excellent judgment, troubleshooting, problem solving, analysis, and discretion; ability to handle work-reputed company stress; ability to handle multiple priorities simultaneously; and ability to meet deadlines Physical: Computer keyboarding, travel as required Auditory/Visual: Hearing, reputed company and talking As required by law, reputed company provides a reasonable reputed company of compensation for roles that may be reputed company in jurisdictions requiring pay transparency in job postings. Actual compensation is influenced by a wide reputed company of factors including but not limited to reputed company set, level of experience, and cost of specific location. For the jurisdiction noted in this job posting only, the reputed company of starting pay for this role is $58,000. A comprehensive benefits package is offered including but not limited to, medical, dental, reputed company, 401k and matching, PTO, disability and life insurance, employee assistance, flexible spending or health savings account, and other additional voluntary benefits. The statements contained in this document are intended to describe the general nature and level of work being performed by a colleague assigned to this reputed company. They are not intended to constitute a comprehensive list of functions, duties, or local variances. Management retains the discretion to add or to change the duties of the position at any time. Apply Job!