PIP Specialist Trainee

Details

Responsible for the investigation, valuation, establishment of exposure, negotiation and settlement of assigned No-fault and Med pay claims within a stipulated monetary authority. Ensures that all assigned claims are concluded promptly, equitably and economically within the provisions of the policy contract and in accordance with the damages presented. Since this is an entry level position, the incumbent works with minimal authority under the direct supervision of a Unit Manager and the Manager of Training.

Position Responsibilities:

• Attends and successfully completes Basic Claims School and any other programs of study selected for the employee's training.
• Participates in and completes specific Pictorial Courses and other selected self-study courses during a defined period of time. Before being eligible for promotion within the PIP area the following Pictorials must be completed with a passing score: Medical Tests and Signs, Interpreting Medical Reports, Personal Auto Coverage, Property Casualty Basics, Claims Investigation, Claims Statements and Legal Concepts and Doctrines.
• The PIP Specialist Trainee must maintain a passing average in all formal courses that have been developed for the individual. Formal Performance Evaluations must result in a “Meets Expectation” or higher rating. An acceptable level of competencies pertaining to the position must be maintained.
• Must begin to prepare for any State Licensing exams required to fulfill licensing requirements in the states to be handled.
• For a period of two to four weeks, the PIP Specialist Trainee may work in Loss Reporting or Subrogation. Here the employee learns the basic functions of the Claim System, takes loss reports, secures recorded statements and will interact with Insureds, Claimants and others in the initial stage of a claim as well as handling assigned subrogation claims for recovery.
• Reviews loss for purposes of coverage verification and to determine exposures. Recommends and enters potential exposures into the system for approval within 72 hours of receipt.
• If coverage cannot be verified, refers to manager for further instructions and completes coverage investigation as directed.
• Contacts Insureds and Claimants to determine extent of injuries and expected future expenses. Conducts investigation as directed by manager.
• With the guidance of the manager, determines eligibility of benefits and priority of coverages available. Becomes familiar with the No-fault laws of States assigned.
• Sends appropriate No-fault forms or other forms required to appropriate parties.
• Answers correspondence received in conjunction with the claim and returns phone calls in a timely manner.
• Handles all claims within the guidelines of the state to which assigned and in conjunction with insurance laws and any other laws applicable to that claim. Adheres to Fair Claim Practices Acts established within a respective state.
• Makes investigative reports promptly to the file with clear and concise file documentation. Other reporting is done as required in conjunction with Company procedures established for the construction of the claim file.
• Communicates effectively both orally and in writing with management and non-management personnel. Also communicates with agents, attorneys, doctors, hospitals and employers, Insureds and Claimants.
• Audits and verifies medical bills, wage statements and other documents submitted as proof of loss and disability to determine benefits due in accordance with No-fault law, policy and standards of "reasonable and customary".
• With the guidance of the manager, determines benefits to be paid and assesses need for additional documentation. All payments and requests are to be made within the guidelines of the State regulations.
• Negotiates reasonable costs with the service providers under the guidance of the manager with loss payments to be entered promptly into the system.
• Recognizes availability of referral services such as Preferred Provider Organizations, Independent Medical Examiners and learns to identify the cases suited for such referrals.
• Maintains a working diary that has been established on each claim file assigned within departmental guidelines.
• Identifies cases where recovery is possible and sends subrogation notices to appropriate parties.
• Assigns appraisals when required, within company guidelines for Best Practices.
• Ensures all time sensitive documents are handled timely and properly.
• Appropriately refers all claims/exposures to the attention of management and the National Casualty Unit as outlined per company guidelines.
• Must have regular predictable attendance.
• Performs all other duties as assigned.

Position Qualifications:

• Candidates must have a high school degree with a minimum of 1 year full time work experience after graduation. A 4 year college degree is preferred.
• Must have good computer skills.
• Must have good planning and organizing skills.
• Must have excellent written and verbal communication skills. Some positions may require specific bilingual skills.
• Must have the ability to deal with conflict.