PIP Claims Evaluator
2 weeks ago
As a Personal Injury Protection ("PIP") Claims Evaluator, your primary role will be to assess and manage claims associated with Personal Injury Protection coverage under various insurance policies. You will conduct investigations, evaluate injuries, negotiate settlements, and ensure adherence to applicable laws and regulations.
Key Responsibilities
- Analyze and evaluate PIP claims to ascertain coverage, liability, and injury severity.
- Conduct comprehensive investigations into each claim's circumstances, including gathering medical records, police documentation, and witness statements.
- Assess the nature and extent of injuries reported by claimants through medical evidence, diagnostic evaluations, and expert assessments.
- Determine the relevance of PIP coverage based on policy specifics, state laws, and individual claim details.
- Negotiate fair settlements with claimants, legal representatives, and healthcare providers to effectively resolve claims.
- Maintain meticulous records of claim files, including all correspondence, investigation outcomes, settlement proposals, and payment details.
- Communicate effectively with claimants, legal counsel, medical professionals, and other involved parties to provide updates, address issues, and facilitate the claims process.
- Ensure compliance with all relevant regulations, laws, and company policies throughout the claims management process.
- Deliver outstanding customer service to claimants by promptly addressing inquiries and providing assistance throughout the claims journey.
- Stay informed on industry trends, legal changes, and medical advancements related to PIP claims to enhance your expertise and effectiveness in this role.
Qualifications
- Bachelor's degree or equivalent professional experience.
- Prior experience in claims adjusting, particularly with a focus on PIP claims.
- Strong understanding of insurance principles, coverage types, and regulations pertaining to PIP.
- Excellent analytical abilities to evaluate complex situations and make informed decisions.
- Effective negotiation skills to resolve conflicts and disputes amicably.
- Exceptional verbal and written communication skills, with the ability to convey information clearly.
- Detail-oriented with strong organizational and time management capabilities.
- Proficiency in relevant software for claims management and documentation.
- Experience with non-standard insurance claims is preferred.
- PA P&C/All Lines License is preferred.
First Chicago Insurance Company offers a competitive benefits package to all full-time employees, including:
- Competitive Salaries
- Commitment to Training & Development
- Medical and Dental Coverage
- Telemedicine Benefits
- 401k with a generous company match
- Paid Time Off and Holidays
- Tuition Reimbursement Programs
- Wellness Initiatives
- Company-sponsored events
- And much more
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