Claims Representative
Farmingdale , New Jersey
January 26, 2017
Exciting new opportunity in Wall! This is a 6 month contract opportunity slated to begin in December.

This associate will be responsible for evaluating PIP and Med Pay claims for eligibility, medical necessity, and appropriateness of charges in accordance with the NJ fee schedule. You will determine casualty and the appropriateness of treatment based on the compensable injury, and assess payments based on policy provisions, state mandates/regulation, and departmental policy and procedures.

Responsibilities include but are not limited to the following:

Essential Responsibilities
• Accurately pay claims based on policy provisions, state regulations, fee schedule and best practices.
• Initiates immediate contact with injured parties to obtain a recorded statement on injuries and the facts of the loss.
• Determines and investigates eligibility on all personal injury claims.
• Collaborates with our internal nurse case management unit on pre-certifications, medical necessity, independent medical exams and medical director reviews.
• Partners with SIU and Subrogation to identify suspicious activity and subrogation claims.
• Has the ability and knowledge to review medical bills and identify fee schedule compliance, up-coding and causality.
• Has the knowledge and ability to assume responsibility of a pending desk and focus on reviewing PIP claims for future handling and large loss reporting.
• Utilizes our claim, imaging, and third party systems daily to track the outcomes of claims.
• Must have the ability to review reports and analyze your contribution to the overall department and make modifications when needed.
• Communicates regularly with policy holders, agents, providers and internal customers through email, phone and mailing correspondence.
• Initiates and conducts follow up on claims in accordance to company best practices by utilizing our automated diary system, reports and scorecard results.
• Other duties/projects as assigned.

Essential Education and Experience

• Bachelor's degree with 3-5 years New Jersey PIP Experience and/or equivalent combination of experience and education.
• Strong knowledge pertaining to the NJ Fee schedule, Medical Terminology and the NJ PIP Regulation and Requirements.
• Experience with Microsoft Outlook, Word, Excel and Access.
• The ability to review reports and data and articulate your assessment and findings to your supervisor and/or upper management.
• Proven ability to meet customer needs while promoting and providing exemplary service by informing customers of the claims process and ensuring a positive experience.
• Strong organizational and time management skills are required for this position.

Preferred Experience

• Familiar with New Jersey Fee Schedule Coding
• Strong analytical background
• Experienced with compliance and pattern and practice reviews

Pay $25-$30/hour based on experience

Please apply now, or call 732-530-3500 ASAP for more info!

Preferred Experience

• Familiar with New Jersey Fee Schedule Coding
• Strong analytical background
• Experienced with compliance and pattern and practice reviews

A little about us:
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