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PIP Claims Analyst I

2 months ago

Hammonton, New Jersey, United States NJM Insurance Group Full time

PIP Claims Analyst I

Company: NJM Insurance Group

Location: Hammonton, NJ

About 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 allowed us to thrive for over a century. We offer a supportive environment where employees can grow professionally while contributing positively to the community.

Position Overview

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

Key Responsibilities
  • Analyze PIP coverages, identifying any coverage discrepancies while investigating and assessing the loss event and associated injuries.
  • Evaluate claims for potential fraud indicators and underwriting concerns, ensuring compliance with state and company regulations.
  • Make informed coverage determinations within regulatory frameworks, 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, durable medical equipment, and peer reviews, communicating decisions promptly.
  • Coordinate Independent Medical Examinations and determine the necessity for additional treatments or benefit terminations.
  • Establish and adjust reserves for medical and non-medical benefits as required.
  • Process non-medical benefits such as wages and essential services efficiently.
  • Demonstrate a thorough understanding of regulatory requirements across various states.
  • Utilize all applications effectively while managing time and responsibilities.
Qualifications
  • 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 decisions and manage multiple tasks simultaneously.
  • A bachelor’s degree is preferred.
  • Knowledge of regulatory requirements applicable by state.
  • 3-5 years of claims handling experience is preferred, especially in out-of-state contexts.

NJM Insurance Group is an equal opportunity employer committed to fostering a diverse and inclusive workforce.