03/28/2022

Claims Representative - PIP & Med Pay

  • SECURA Insurance
  • Detroit, MI, United States
Full Time

Job Description

This career opportunity can be based in the Neenah office or remote.



Job Requirements:

ESSENTIAL DUTIES AND RESPONSIBILITIES:

  • Analyze, review, negotiate, and settle PIP and Med Pay claims of varying complexity in a thorough manner, with minimal supervision
  • Establish and monitor reserves to adequately reflect the exposure and make appropriate changes as each file develops
  • Examine policy coverage forms, for both personal and commercial policies, and other records to determine insurance coverage
  • Interview, telephone, and correspond with policyholders, claimants, and witnesses
  • Assist in agency management by providing feedback to Underwriting
  • Review medical records and bills to substantiate treatment and confirm whether or not wage loss is accident-related
  • Familiarity with medical bill review processes and Medicare reporting
  • Proactively follow-up with injured parties to discuss treatment protocol and injury status
  • Determine the need for independent medical exams when necessary
  • Identify subrogation potential and refer to the Subrogation Team
  • Actively participate in or handle additional projects and/or claims as assigned by Claims management
  • Occasional travel
  • Participate in depositions or trials as needed

QUALIFICATIONS: 

  • Bachelor's degree (B.A.) from four-year college or university; or equivalent combination of education and experience
  • Two or more years of Michigan PIP experience preferred
  • Strong organizational skills including the ability to multi-task
  • Detail oriented
  • Fundamental understanding of medical terminology
  • Excellent written and verbal communication skills
  • Self-starter with the ability to independently work through and solve problems
  • Working knowledge of Michigan no-fault
  • AIC or similar designations preferred

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