PIP Claims Representative

CURE Auto Insurance (Citizens United Reciprocal Exchange); Princeton (NJ); Hybrid; USD 45,000 - 65,000; Full time

Benefits offered by this job

Paid time off

Flexible FSA & HSA options

Life and AD&D insurance

401(k) with company match

Voluntary benefits (legal services,pet

Identity & fraud protection

Employee Assistance Program (EAP)

Health & wellness perks

In-office culture events

Job summary

CURE Auto Insurance is seeking a PIP Claims Representative in Detroit, MI or Princeton, NJ to handle the investigation, evaluation and disposition of complex Personal Injury Protection claims. The role involves verifying coverage, eligibility, and determining course of action while maintaining detailed claim files.

Responsibilities include thorough investigations, determining PIP eligibility and injury extent, establishing reserves, coordinating with medical case managers, and communicating with

Qualifications

• Bachelor's degree or commensurate experience in insurance or customer service.
• Minimum of 2 years customer service or commensurate medical experience preferred.
• Must have excellent customer service skills; the ability to multitask, analyze coverages, liability and damages.

Responsibilities

• Receive assigned claims, verify coverage, confirm eligibility and determine course of action.
• Complete detailed claim investigation through telephone and/or written correspondence with subscribers, attorneys, witnesses and others.
• Analyze information to evaluate the claim, determine PIP eligibility and extent of injuries and claim exposure.
• Establish reserves for the exposure and coordinate with medical case managers or experts when needed.
• Handle inquiries from subscribers, claimants, attorneys and providers and maintain claim diaries.
• Work with Special Investigation Unit, Underwriting, attorneys and others to optimize file results.

Skills

Customer service

Multitasking

Coverage analysis

Liability assessment

Education

Bachelor's degree or commensurate experience

Job description

CURE Auto Insurance is a leading direct writer of auto insurance in New Jersey, Pennsylvania, and Michigan. CURE offers a great working environment, competitive salary, and comprehensive benefits package which includes health and dental coverage, life and disability insurance, 401k with generous company match, and much more!

The PIP Claims Representative will handle the investigation, evaluation and disposition by settlement, payment, or denial of complex Personal Injury Protection claims. Ensure that claims are processed within company policies, procedures, regulatory requirements, and the individual's prescribed authority with high standards of performance.

Essential Job Functions

Receive assigned claims, verify coverage, confirm eligibility and determine course of action.

Complete detailed, thorough claim investigation through telephone and/or written correspondence with subscribers, attorneys, witnesses and any others with information relevant to the claim.

Analyze information obtained through investigation in order to evaluate the claim, determine PIP eligibility and determine the extent of the injuries and claim exposure.

Establish and maintain the proper reserves for the exposure.

Assign medical case managers or other experts to a case when appropriate and arrange for independent medical examinations when necessary to determine medical necessity and causal relationship of treatment.

Handle incoming calls and correspondence from subscribers, claimants, attorneys and providers regarding questions or problems associated with a claim.

Document claim files and maintain a diary system for reporting and claim follow-up.

Handle claims in accordance with CURE's Decision Point Review Plan.

Work closely with the Special Investigation Unit, Underwriting Department, attorneys, and other members of the Claim Department to ensure that CURE achieves optimum results on all files.

Manages allocated loss adjustment expense. Employs outside vendors when activities cannot be completed by a staff member and directs the activities of vendors to ensure only necessary work is completed

Comply with all conditions outlined in the Unfair Claim Practices Acts.

Perform other duties as assigned.

Requirements

Education: Bachelor's degree or commensurate experience in the insurance industry or customer service

Years/Type of Experience: A minimum of 2 years customer service or commensurate medical experience preferred.

Specific Skills: Must have excellent customer service skills; the ability to multitask, analyze coverages, liability and damages.

Other Required or Preferred Qualifications: Detail oriented with strong written and verbal communication skills. Must be able to work independently as well as possess strong interpersonal skills necessary to contribute as a team player.

• Generous paid time off(PTO days, sick days, and holidays)
• Flexible spending optionswith FSA & HSA plans
• Life and AD&D insurance
• 401(k) with company match
• Voluntary benefitssuch as legal services, pet insurance, and identity & fraud protection
• 24/7 Employee Assistance Program (EAP)for employees and their families
• Health & wellness perksincluding gym discounts, wellness reimbursements, and reward programs
• Fun, engaging in-office eventsthat support our culture

Schedule

We offer flexible work hours between 8:00 AM and 5:00 PM, and employees can choose a schedule that works best for them—8:00 AM–4:00 PM, 8:30 AM–4:30 PM, or 9:00 AM–5:00 PM. While we aim to support individual preferences, final schedules may be adjusted based on business needs to ensure great coverage and teamwork.

We offer a hybrid work schedule: team members work onsite 4 days per week and have the flexibility to work remotely 1 day per week.

Location

Detroit, MI or Princeton, NJ

We recruit, hire, employ, train and promote, and compensate individuals based on job-related qualifications and abilities. We respect the dignity and worth of each individual and are committed to an employment environment that is free from all forms of employment discrimination.

CURE Auto Insurance provides equal employment opportunities to all employees and applicants for employment and prohibits discrimination and harassment of any type without regard to race, color, religion, age, sex, national origin, disability status, genetics, protected veteran status, sexual orientation, pregnancy, gender identity or expression, or any other characteristic protected by federal, state or local laws.

This policy applies to all terms and conditions of employment, including recruiting, hiring, placement, promotion, termination, layoff, recall, transfer, leaves of absence, compensation and training.

Disclaimer: This job description reflects management's assignment of essential functions; it does not prescribe or restrict the tasks that may be assigned. This job description may be subject to change at any time.

Applicants must be authorized to work for ANY employer in the U.S. We are unable to sponsor or take over sponsorship of an employment Visa at this time.