PIP Claims Analyst I

PIP Claims Analyst I

Company: NJM Insurance Group

NJM 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 where employees can thrive, develop their skills, and contribute to the community.

We are currently seeking a detail-oriented PIP Claims Analyst I to join our Hammonton Medical Services Administration team. This role is ideal for individuals who excel in a dynamic setting and possess strong organizational skills.

• Assess PIP coverages and investigate coverage concerns, analyzing loss events and injuries to determine appropriate actions.
• Identify potential fraud indicators and underwriting issues, ensuring compliance with state regulations and company policies.
• Make final coverage determinations while maintaining clear communication with all parties involved throughout the claims process.
• Document all actions taken during the claims lifecycle accurately and concisely.
• Manage requests for medical treatments and equipment, ensuring timely communication of determinations.
• Coordinate Independent Medical Examinations and make informed decisions regarding treatment extensions or benefit terminations.
• Establish and adjust reserves for medical and non-medical benefits as necessary.
• Calculate and issue non-medical benefits, including wages and essential services.
• Demonstrate a thorough understanding of regulatory requirements across various states.
• Utilize process knowledge related to arbitration and subrogation effectively.

• Strong verbal and written communication skills, with proficiency in Microsoft Office Suite.
• Excellent interpersonal and customer service abilities.
• Effective organizational and time-management skills.
• Ability to make sound decisions and manage multiple tasks simultaneously.
• A Bachelor's degree is preferred.
• Experience in claims handling is advantageous, particularly in out-of-state contexts.

NJM Insurance Group is committed to fostering a diverse and inclusive workforce that reflects the communities we serve.