Commercial Auto No Fault / PIP Claims Examiner II

Job DetailsLevel: ExperiencedJob Location: Philadelphia Office - Philadelphia, PA 19107Position Type: Full TimeEducation Level: High School Diploma or GEDSalary Range: $65,000.00 - $72,000.00 Salary/yearTravel Percentage: NoneJob Shift: DayJob Category: Admin - ClericalThis is a hybrid position that requires 2 - 3 days at client location in Philadelphia, PA.

 

POSITION SUMMARY:  Responsibilities include but are not limited to:

 

 

DUTIES AND RESPONSIBILITIES:


Experience 3-5 years of handling Pennsylvania, Auto No Fault /PIP claims
Ability to multi-task and prioritize the tasks at hand.
Ability to perform data entry, email, calendar management, Word and Excel functions.
Needs to have excellent verbal and written communication skills.
Strong interpersonal and customer service skills
 Review PIP/ No Fault 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.
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.
Investigate prior losses and other information on file and orders reports as needed.
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 (Reservation of Right letter, etc.)
Need to recognize prolonged or excessive treatment and promptly schedule an IME with the appropriate medical profession via an approved company vendor.
Generates and sends appropriate forms to insured/claimant for completion.
Processes claims payments.
Completes all necessary forms, logs documents into the system, and routes them to the appropriate parties.
Need to be an effective team player.
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).


 

 

EQUIPMENT OPERATED/USED: Computer, 10-key, printer, copier, fax/scanner machine and other office equipment.

 

 

SPECIAL EQUIPMENT OR CLOTHING:     Appropriate office attire

 

 
QualificationsQUALIFICATIONS REQUIRED:

 

Education/Experience:  High school diploma or GED required; Bachelor’s degree in related field (preferred) and a minimum of 3 - 5 years Pennsylvania, Commercial Auto No Fault / PIP casualty related experience; or equivalent combination of advanced education and experience.

 

Knowledge, Skills and Abilities:

 


At least 3 - 5 years Pennsylvania, Commercial Auto No Fault / PIP liability claims experience required.  Additional experience handling auto liability claims is a plus.
Knowledge of claims handling concepts, practices and techniques, including but not limited to coverage issues and product line knowledge.
Demonstrated verbal and written communications skills.
Demonstrated advanced analytical, decision making and negotiation skills.
Computer proficiency.
Ability to communicate effectively and clearly, both orally and in writing.



Ability to manage relationships in a fast-paced environment, while demonstrating problem solving and decision-making skills to work with customers.
Good analytical abilities to review, exercise judgment and evaluate claims in order to make sound decisions with a minimal amount of supervision.
Excellent customer service skills.
An understanding of the litigation process and case valuation in multiple jurisdictions.
Ability to carry out detailed written or verbal instructions, ability to respond to requests effectively and efficiently and exhibit good common sense.
An ability to handle assigned claims following company guidelines and industry best practices with a minimal amount of supervision.
Time management skills, organizational skills and ability to prioritize issues and tasks.
Ability to effectively operate computer equipment and applications.
Independence, flexibility and creativity.


 

 

 

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