Personal Injury Protection; PIP) Claims Representative

We believe that helping you is what we do best. We achieve this goal by operating as a team with each employee playing an important role. We are a statewide "Equal Opportunity Employer" offering positions such as: clerical support, policy processing, administrative, management, computer information systems, claims, finance and underwriting.

SUMMARY:

We are looking for a PIP Claims Rep to work in our Gainesville office. You will be responsible for managing and adjusting medical insurance claims under Personal Injury Protection and/or Medical Payments coverage.

• Review, investigate, and process PIP and/or Medpay claims in accordance with applicable laws and policy provisions.
• Determine coverage eligibility, verify medical necessity, and assess reasonableness of charges.
• Communicate with claimants, medical providers, attorneys, etc. to gather necessary documentation to resolve claims.
• Maintain detailed and accurate claim files and documentation.
• Provide clear and empathetic communication to claimants and stakeholders.
• Address inquiries and resolve issues promptly and professionally.
• Prepare reports and summaries for management as needed.
• Regular and predictable attendance is required.

To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge, skill, and/or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

• H.S. Diploma is required
• Must obtain Adjuster’s license in 6 months
• Customer service experience
• Familiarity with medical terminology & treatment protocols

• Proficient in English written and Verbal communication skills
• Possesses strong technical aptitude
• Proficient PC skills
• Good math skills

The above statements are intended to describe the general nature and level of work being performed. They are not intended to be construed as an exhaustive list of all the essential duties, responsibilities and requirements of personnel.