Claims Specialist II, PIP
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Job Description
Investigate and manage Personal Injury Protection (PIP) Claims while providing excellent customer service at Mercury Insurance. Requires knowledge of claims processes and medical terminology.
Responsibilities:
- The primary job function is to investigate and manage Personal Injury Protection (PIP) Claims.
- Identifies and contacts each injured party to explain coverage and claims process.
- Verifies coverage, eligibility and determines the Company’s course of action.
- Maintains claims files, evaluates claims using facts and supporting data on injury and wages lost due to injury.
- Updates appropriate parties as needed, providing new facts as they become available, and their impact upon the analysis and settlement options.
- Verifies the nature and extent of injury and/or wages lost by obtaining and reviewing appropriate records and documentation.
- Carefully and thoroughly reviews all pertinent information and forwards the file to the Special Investigations Unit (SIU) when there is reasonable cause.
- Reviews and analyzes all information and submits request for payment of claims within company guidelines to supervisor.
- Thoroughly documents injury and treatment information as well as bills received for treatment and payments issued.
- Contacts medical providers and injured parties to verify medical provider information, treatment received, and billing status. Submits files to supervisor for audit upon closing.
- Maintains current knowledge of claims settlement procedures, state regulation, and policy changes.
- Includes completion of the formal claims training program, which may require overnight travel for at least 1 week.
Requirements:
- Minimum: High School Diploma or GED
- Completion of in-house training program
- You may be required to obtain a Company sponsored Adjuster’s license to handle claims, to be secured upon hire
- Minimum: At least 6 months of related experience
- Or equivalent combination of education and experience
- Minimum: Solid comprehension of basic principles and practices of Company policies upon completion of formal and informal Claims Training.
- Ability to exercise sound judgment when interacting with customers and claimants.
- Requires extensive knowledge of medical terminology, and medical coding (CPT and ICD-10 coding).
- Requires extensive knowledge of Personal Injury Protection coverage(s), applicable state statutes/regulations.
- Has a passion for serving customers in their time of need.
- Possesses advanced written and verbal communication skills to professionally represent the Company in multi-channel correspondence with internal and external customers.
- Collaborates well with others. We are one team with a common goal.
- Ability to build rapport utilizing emotional intelligence.
- Views conflict resolution as an opportunity.
- Has self-motivation and accountability while working remotely.
- Demonstrated proficiency with MS Office products (Outlook, Word, Teams) and claims related software.
- Preferred: Critical attention to detail and strong organizational skills.
- Demonstrates intellectual curiosity by seeking out efficiencies through process improvement or technology.
- Takes ownership of any process they can improve.
- Assumes positive intent in all interactions.
- Seeks growth within and beyond this role.
Benefits:
- Competitive compensation
- Flexibility to work from anywhere in the United States for most positions
- Paid time off (vacation time, sick time, 9 paid Company holidays, volunteer hours)
- Incentive bonus programs (potential for holiday bonus, referral bonus, and performance-based bonus)
- Medical, dental, vision, life, and pet insurance
- 401 (k) retirement savings plan with company match
- Engaging work environment
- Promotional opportunities
- Education assistance
- Professional and personal development opportunities
- Company recognition program
- Health and wellbeing resources, including free mental wellbeing therapy/coaching sessions, child and eldercare resources, and more
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