Claim Representative I, Personal Injury Protection Unit

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Job description

Overview:
The Claim Representative-PIP Unit handles no-fault claims from all claim offices within the state of Kentucky to ensure efficient and effective processing of Personal Injury Protection (PIP) benefits.

Responsibilities:
ESSENTIAL FUNCTIONS

Accept assignment of PIP claims from claim adjusters.

Monitor continuing eligibility of PIP claimants.

Receive, investigate, coordinate, and pay appropriate PIP benefits in timely manner according to statute requirements.

Maintain proper reserves.

Process incoming and outgoing mail in regards to PIP Unit.

Create and type correspondence and issue form letters to investigate, resolve and responds to questions relating to PIP benefits.

Receive telephone and personal inquiries relating to PIP files by policyholders, customers, attorneys and medical providers, providing assistance where appropriate or referring to other staff if necessary.

Assure high customer satisfaction levels through professionalism, integrity, fairness and promptness.

Assist and cooperate with all company personnel.

Maintain PIP files to comply with statute requirements.

Monitor the claim inventory report to ensure proper closure of files.

Pursue professional development.

Report claims as required by claims manual or by district claims manager.

Serve as a catastrophe team member or assist in other claim offices or locations as required.

Regular, predictable attendance as employee has to physically be in the office.

This list of essential functions is non-exhaustive and may be supplemented as necessary.

OTHER RESPONSIBILITIES

Establish companion PIP work file.

Secure appropriate PIP documents, i.e., medical reports, wage verifications, PIP applications.

Obtain initial claim payment authority on each claimant from claim adjusters.

Diary all companion claim files to comply with statute requirements.

Furnish copy of PIP application, medical reports and wage verification to claim adjusters as requested.

Receive, investigate and pay medical bills, wage loss benefits, survivor's economic benefits, replacement service benefits and funeral expense benefits.

Maintain appropriate reserves for both basic and added reparation benefits.

Perform claim file maintenance transactions via terminal entry.

Receive and review loss reports on a regular basis from agents, claim adjusters and senior adjusters.

Establish claim files using data from loss reports.

Type letters and forms required to properly investigate and document payment of no fault benefits.

Transmit recoveries to the Accounting Department on a timely basis.

Report claims as required by Claim Manual or by District Claims Manager.

Promptly respond to complaints as requested.

Report immediately the receipt of all summonses to PIP Unit Supervisor and handle as directed.

Review claim inventory reports monthly and make needed adjustments.

Make corrections on claim files as recommended by PIP Unit Supervisor or Team Lead following review.

Document claim files to support actions taken. (See claim manual)

May be called upon to handle first party claims and non-disputed liability claims.

May be called upon to assist on evaluation of inventory sheets for property loss claims.

Attend and participate in company meetings, seminars and other company sponsored educational activities at the request of the company.

May work a late Friday on a rotating basis to provide customer service to claims offices, agents and providers.

Attain the Certificate in General Insurance from Insurance Institute of America.

Maintain current knowledge of policy contracts and statute.

JOB SPECIFICATIONS

Physical demands: Normal vision/hearing with or without correction; Sitting.

Mental demands: Analytic reasoning; Prolonged concentration.

Environmental factors: Standard office lighting, temperature, and noise.

Equipment: Keyboard; Telephone; Calculator; Copier/Fax.

Qualifications:
Associate degree or combination of formal education, training, and experience to acquire knowledge and skills generally equivalent to those possessed by a two-year college graduate. Bachelor's degree preferred.

Required to obtain an Adjuster License within one year of hire date.

Previous experience in a claims or insurance office desirable.

Average typing skill (minimum 35 wpm).

Knowledge of claims handling procedures and insurance contracts.

Experience in the use of photocopier, computer terminal or word processor and other office equipment.

Ability to communicate with high level of skill both orally and in writing.

Ability to make timely decisions.

Excellent human relation skills and self-motivation required.

Ability to act in a confidential manner.

Knowledge of word processing software.