Personal Injury Protection Claims Specialist

2 weeks ago

Dubuque, Iowa, United States Access Dubuque Full time

Personal Injury Protection Claims Specialist

Access Dubuque

1 Position Available

Job Overview

At Access Dubuque, we prioritize the well-being of our team members, fostering a culture that values care and support. A career with us means enjoying flexibility and the opportunity to balance your professional and personal life. We are committed to helping you grow your skills and advance your career in a diverse and inclusive environment.

Joining Access Dubuque means you will be part of a team that is dedicated to making a positive impact through our services. If you are passionate about helping others and thrive in a challenging environment, we welcome you to explore this opportunity.

PRIMARY PURPOSE: To investigate, negotiate, and resolve personal injury protection (PIP) and medical payments claims in accordance with policy guidelines and legal requirements. This role involves managing claim data and assisting insured individuals and claimants throughout the claims process.

ESSENTIAL FUNCTIONS and RESPONSIBILITIES

  • Oversee and adjust moderately complex to complex PIP/Med Pay claims across various jurisdictions.
  • Conduct thorough investigations, evaluate claims, negotiate settlements, and resolve issues within established authority limits while maintaining confidentiality and high customer service standards.
  • Review assigned claims for proper handling, establish reserves, and issue payments based on the details and damages of each claim.
  • Document all actions taken, including investigations, evaluations, negotiations, and settlement decisions clearly and accurately.
  • Prioritize claims workload to keep policyholders and other stakeholders informed, providing timely updates on claim status.
  • Act as a subject matter expert on state laws, regulations, and procedures to ensure proper claims handling.
  • Deliver exceptional claim service through proactive communication with customers, brokers, and other professionals involved in the claims process.
  • Work independently on assignments of higher technical complexity while coordinating with team members to resolve issues and escalate matters as necessary.
  • Identify potentially suspicious claims and conduct recorded statements as needed.
  • Make informed coverage decisions on complex claims.

ADDITIONAL FUNCTIONS and RESPONSIBILITIES

  • Perform other duties as assigned.
  • Travel may be required.

QUALIFICATIONS

Education & Licensing

A Bachelor's degree from an accredited institution is preferred. Licenses as required by law.

Experience

A minimum of six (6) years of relevant experience, including three (3) years in PIP/Med Pay adjusting, or an equivalent combination of education and experience is required.

Skills & Knowledge

  • In-depth knowledge of auto claims contracts and applicable case law, state laws, and regulations.
  • Ability to interact with internal and external clients in a professional and courteous manner.
  • Strong discretion in business relationships and sound judgment.
  • Excellent verbal and written communication skills, including the ability to present information effectively.
  • Proficient in Microsoft Office and other relevant software.
  • Strong analytical and interpretive skills.
  • Exceptional organizational and interpersonal skills.
  • Proficient negotiation skills.
  • Ability to produce comprehensive, accurate, and constructive written reports.
  • Ability to collaborate effectively within a team environment.
  • Ability to meet or exceed performance metrics.

WORK ENVIRONMENT

Consideration will be given to reasonable accommodations when applicable.

Mental: Ability to think clearly and conceptually; strong judgment, problem-solving, and analytical skills; capacity to manage work-related stress and multiple priorities effectively.

Physical: Proficient in computer keyboarding; travel may be necessary.

Auditory/Visual: Ability to hear, see, and communicate effectively.

The details provided in this document outline the general nature and level of work expected from a colleague in this role. They are not intended to be an exhaustive list of all functions, duties, or local variations. Management retains the right to modify the duties of the position at any time.

Pay Transparency:

Access Dubuque provides a reasonable range of compensation for roles that may be hired in jurisdictions requiring pay transparency in job postings. Actual compensation is influenced by various factors, including skill set, experience level, and location. A comprehensive benefits package is offered, including medical, dental, vision, 401k with matching, PTO, disability and life insurance, employee assistance programs, flexible spending accounts, and other voluntary benefits.

Access Dubuque is an Equal Opportunity Employer and maintains a Drug-Free Workplace.

If you are interested in this role but your experience does not align perfectly with every qualification, we encourage you to apply anyway. Access Dubuque is committed to building a diverse, equitable, and inclusive workplace and recognizes that each individual brings a unique combination of skills, knowledge, and experience.

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