Medical Claims Adjuster I
4 months ago
**Medical Claims Adjuster I (PIP Rep I)**
Hammonton, NJ
**NJM Insurance Group**
**
When you join the NJM family, you’ll work with talented people who care about doing the right thing by our policyholders as well as each other. You’ll be part of a financially strong and stable company that has flourished on relationships, integrity and service for more than a century. NJM is a special place where you can propel your career, help others and make friends – all at the same time.
NJM is proud to offer our employees continuous learning options, outstanding benefits, access to wellness programs, and a wide range of opportunities to give back to the communities we are privileged to serve.
Our strategic plan for regional expansion is underway. Thanks to both customer and employee dedication, NJM was recently ranked #1 in the nation for auto claims satisfaction by J.D. Power. We were also voted as one of the best places to work in NJ - as noted by Forbes. Come join us ** keywords: position summary,analysis,medical,process,management,compliance,communication,skills,education,experience,knowledge
Full Time
**Overview**: Our Hammonton Medical Services Administration team is in search of a PIP Claims Representative. This exciting opportunity is great for someone who is highly organized and enjoys working in a fast-paced environment.
Reporting to the immediate 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. Entity of type com.vizirecruiter.common.domain.model.Label with id: 7159 **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).
- Demonstrates knowledge in NJ and in other states and is able to apply regulatory requirements appropriately.
- Understands and applies all process and regulatory knowledge associated with arbitration and subrogation. Effectively utilizes all applications and manages time and responsibilities.
- 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
- Able to apply regulatory requirements appropriate by state
- Thorough understanding of all process and regulatory knowledge associated with arbitration and subrogation
- 3-5 years of claims handling experience preferred with out of state (CT, OH, MD, DE) experience strongly preferred
For more information:
website:
Legal Disclaimer: 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.
**Responsibilities**
48_Analyze Created with Sketch. Analysis
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 ... 48_Medical Created with Sketch. Medical
Request necessary Independent Medical Examinations and render determinations for additional treatment or termination benefits. 48_Individual Contributor Created with Sketch. Process
Understands and applies all process and regulatory knowledge associated with arbitration and subrogation. Concisely and accurately document all actions taken ... 48_Management Created with Sketch. Management
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 ... 48_Compliance Created with Sketch. Compliance
Conduct activities in compliance with state and company regulations and guidelines. Establish adequate medical and non-medical benefits reserves for the life of the claim and ... 48_Communication Created with Sketch. Communication
Render final coverage determination within regulatory guidelines: Maintain communication with involved parties during the course of the claim, via written and/or verbal ... **Requirements**
48_Assessment Created with Sketch. Skills
Strong interp
-
PIP Claims Analyst I
4 weeks ago
Hammonton, New Jersey, United States NJM Insurance Group Full timePIP Claims Analyst ICompany: NJM Insurance GroupLocation: Hammonton, NJAbout NJM Insurance GroupNJM Insurance Group is a reputable organization dedicated to providing exceptional service to our policyholders. Our commitment to integrity and strong relationships has allowed us to thrive for over a century. We offer a supportive environment where employees can...
-
PIP Claims Analyst I
4 weeks ago
Hammonton, New Jersey, United States NJM Insurance Group Full timePIP Claims Analyst ICompany: NJM Insurance GroupAbout NJM Insurance GroupNJM Insurance Group is a reputable organization dedicated to providing exceptional service to our policyholders. Our commitment to integrity and strong relationships has been the foundation of our success for over a century. We pride ourselves on fostering a supportive work environment...
-
PIP Claims Specialist I
4 weeks ago
Hammonton, New Jersey, United States NJM Insurance Group Full timePIP Claims Specialist ICompany: NJM Insurance GroupLocation: Hammonton, NJAbout NJM Insurance GroupNJM Insurance Group is not just about insurance; it’s about building a community. When you become part of NJM, you engage with dedicated professionals who prioritize integrity and service. Our organization has thrived for over a century, focusing on strong...
-
Workers Comp Adjuster
2 months ago
Hammonton, United States NJM Insurance Group Full time**Workers Comp Adjuster** Hammonton, NJ**NJM Insurance Group** ** This isn’t just insurance. It’s NJM. When you join the NJM family, you’ll work with talented people who care about doing the right thing by our policyholders as well as each other. You’ll be part of a financially strong and stable company that has flourished on relationships,...
-
Workers Compensation Claims Representative
3 weeks ago
Hammonton, New Jersey, United States NJM Insurance Group Full timeJob SummaryWe are seeking a highly skilled Workers Compensation Claims Representative to join our team at NJM Insurance Group. As a key member of our claims department, you will be responsible for investigating and analyzing workers' compensation claims, communicating with policyholders and stakeholders, and managing claims to ensure timely and fair...
-
COVID-19 Field Medical Staff
6 days ago
hammonton, United States IntelyCare Full timeEnjoy truly flexible schedules and get paid up to $66 per hour as a Registered Nurse (RN) in Hammonton, New Jersey, and surrounding areas. That's why our W2-employed nursing professionals can choose their own shifts at partner facilities and take time off on any day they like. This means you can elevate your nursing career and still have the flexibility for...
-
COVID-19 Field Medical Specialist
6 days ago
Hammonton, New Jersey, United States IntelyCare Full timeUnlock Your Nursing Potential with IntelyCareAs a Registered Nurse (RN) with IntelyCare, you'll enjoy the flexibility to choose your own shifts and take time off on any day you like. Our W2-employed nursing professionals can select from a variety of facilities and shifts, including per diem, overnight, and more.Benefits of Working with IntelyCare:Competitive...
-
Medical Records Nurse
3 days ago
Hammonton, NJ, United States IntelyCare Full timeEnjoy truly flexible schedules and get paid up to $66 per hour as a Registered Nurse (RN) in Hammonton, New Jersey, and surrounding areas. Thats why our W2-employed nursing professionals can choose their own shifts at partner facilities and take time off on any day they like. This means you can elevate your nursing career and still have the flexibility...
-
Nursing Professional
5 days ago
Hammonton, New Jersey, United States IntelyCare Full timeFlexible Nursing Opportunities with IntelyCareAs a Licensed Practical Nurse (LPN) with IntelyCare, you'll enjoy a flexible schedule and competitive hourly pay up to $55. Choose from a variety of shifts and facilities to suit your needs.Benefits of Working with IntelyCareFlexible scheduling with a wide range of shifts and facilitiesEligibility for health...
-
2nd Shift Nursing/LPN
3 weeks ago
hammonton, United States IntelyCare Full timeEnjoy truly flexible schedules and get paid up to $55 per hour as a Licensed Practical Nurse (LPN) in Hammonton, New Jersey, and surrounding areas. That's why our W2-employed nursing professionals can choose their own shifts at partner facilities and take time off on any day they like. This means you can elevate your nursing career and still have the...
-
Licensed Practical Nurse
3 weeks ago
Hammonton, United States IntelyCare Full timeEnjoy truly flexible schedules and get paid up to $55 per hour as a Licensed Practical Nurse (LPN) in Hammonton, New Jersey, and surrounding areas. At IntelyCare, we understand the demands of the job and how a healthy work-life balance contributes to successful patient outcomes. That's why our W2-employed nursing professionals can choose their own shifts at...
-
Licensed Practical Nurse
1 week ago
hammonton, United States IntelyCare Full timeEnjoy truly flexible schedules and get paid up to $55 per hour as a Licensed Practical Nurse (LPN) in Hammonton, New Jersey, and surrounding areas. At IntelyCare, we understand the demands of the job and how a healthy work-life balance contributes to successful patient outcomes. That's why our W2-employed nursing professionals can choose their own shifts at...
-
Licensed Practical Nurse
4 weeks ago
hammonton, United States IntelyCare Full timeEnjoy truly flexible schedules and get paid up to $55 per hour as a Licensed Practical Nurse (LPN) in Hammonton, New Jersey, and surrounding areas. At IntelyCare, we understand the demands of the job and how a healthy work-life balance contributes to successful patient outcomes. That's why our W2-employed nursing professionals can choose their own shifts at...
-
Registered Nurse
6 days ago
hammonton, United States IntelyCare Full timeEnjoy truly flexible schedules and get paid up to $66 per hour as a Registered Nurse (RN) in Hammonton, New Jersey, and surrounding areas. At IntelyCare, we understand the demands of the job and how a healthy work-life balance contributes to successful patient outcomes. That's why our W2-employed nursing professionals can choose their own shifts at partner...
-
Registered Nurse
1 week ago
hammonton, United States IntelyCare Full timeEnjoy truly flexible schedules and get paid up to $66 per hour as a Registered Nurse (RN) in Hammonton, New Jersey, and surrounding areas. At IntelyCare, we understand the demands of the job and how a healthy work-life balance contributes to successful patient outcomes. That's why our W2-employed nursing professionals can choose their own shifts at partner...
-
Registered Nurse
4 weeks ago
hammonton, United States IntelyCare Full timeEnjoy truly flexible schedules and get paid up to $66 per hour as a Registered Nurse (RN) in Hammonton, New Jersey, and surrounding areas. At IntelyCare, we understand the demands of the job and how a healthy work-life balance contributes to successful patient outcomes. That's why our W2-employed nursing professionals can choose their own shifts at partner...
-
Licensed Practical Nurse
1 day ago
Hammonton, United States IntelyCare Full timeEnjoy truly flexible schedules and get paid up to $55 per hour as a Licensed Practical Nurse (LPN) in Hammonton, New Jersey, and surrounding areas. At IntelyCare, we understand the demands of the job and how a healthy work-life balance contributes to successful patient outcomes. That's why our W2-employed nursing professionals can choose their own shifts at...
-
Licensed Practical Nurse
2 days ago
Hammonton, United States IntelyCare Full timeEnjoy truly flexible schedules and get paid up to $55 per hour as a Licensed Practical Nurse (LPN) in Hammonton, New Jersey, and surrounding areas. At IntelyCare, we understand the demands of the job and how a healthy work-life balance contributes to successful patient outcomes. That's why our W2-employed nursing professionals can choose their own shifts at...
-
Nurse Professional
4 days ago
Hammonton, New Jersey, United States IntelyCare Full timeUnlock Your Nursing PotentialAt IntelyCare, we understand the importance of work-life balance for our nursing professionals. That's why we offer flexible scheduling and competitive pay rates, allowing you to choose your own shifts and take time off when you need it.As a Registered Nurse (RN) with IntelyCare, you'll have the opportunity to work in post-acute...
-
Registered Nurse
2 days ago
Hammonton, United States IntelyCare Full timeEnjoy truly flexible schedules and get paid up to $66 per hour as a Registered Nurse (RN) in Hammonton, New Jersey, and surrounding areas. At IntelyCare, we understand the demands of the job and how a healthy work-life balance contributes to successful patient outcomes. That's why our W2-employed nursing professionals can choose their own shifts at partner...