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Claims Specialist II PIP

Key Facts

Remote From: 
Full time
Mid-level (2-5 years)
44 - 78K yearly
English

Other Skills

  • Microsoft Office
  • Organizational Skills
  • Detail Oriented
  • Non-Verbal Communication
  • Rapport Building
  • Teamwork
  • Decisiveness
  • Customer Service
  • Emotional Intelligence
  • Self-Motivation

Roles & Responsibilities

  • High School Diploma or GED with completion of in-house training; company-sponsored Adjuster’s license may be required
  • Bachelor’s Degree preferred
  • Minimum 6 months of related experience or equivalent
  • Strong knowledge of medical terminology and CPT/ICD-10 coding; solid understanding of Personal Injury Protection coverage and state regulations; proficient in MS Office and claims software

Requirements:

  • Identifies and contacts injured parties to explain coverage and claims process; verifies coverage and determines the company’s course of action
  • Maintains and analyzes claims files using injury facts and wage loss data; updates parties with new information and settlement options
  • Verifies injury extent and wage loss by obtaining records; forwards file to Special Investigations Unit when there is reasonable cause
  • Documents injury and treatment information and medical bills; coordinates with medical providers and parties; submits files for audit at closing and stays current on claims procedures and regulations

Job description

Overview: Position Summary:
The primary job function is to investigate and manage Personal Injury Protection (PIP) Claims.

Geo-Salary Information:

An in-person interview may be required during the hiring process

 

State specific pay scales for this role are as follows:

$XX to $XX (CA, NJ, NY, WA, HI, AK, MD, CT, RI, MA)

$XX to $XX (NV, OR, AZ, CO, WY, TX, ND, MN, MO, IL, WI, FL, GA, MI, OH, VA, PA, DE, VT, NH, ME)

$XX to $XX (UT, ID, MT, NM, SD, NE, KS, OK, IA, AR, LA, MS, AL, TN, KY, IN, SC, NC, WV)

The expected base salary for this position will vary depending on a number of factors, including relevant experience, skills and location.

Responsibilities: Essential Job Functions:
-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.

Qualifications: Education:
 
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 
 
Preferred: 
• Bachelor’s Degree
 
Experience:
 
Minimum:   
• At least 6 months of related experience 
• Or equivalent combination of education and experience
 
Skills & Abilities:
 
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.
• Must have dedicated workspace that is free from distractions.
 
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.
About the Company:

Why choose a career at Mercury?

At Mercury, we have been guided by our purpose to help people reduce risk and overcome unexpected events for more than 60 years. We are one team with a common goal to help others. Everyone needs insurance and we can’t imagine a world without it.

Our team will encourage you to grow, make time to have fun, and work together to make great things happen. We embrace the strengths and values of each team member. We believe in having diverse perspectives where everyone is included, to serve customers from all walks of life.

We care about our people, and we mean it. We reward our talented professionals with a competitive salary, bonus potential, and a variety of benefits to help our team members reach their health, retirement, and professional goals.

 

Learn more about us here: https://www.mercuryinsurance.com/about/careers

Perks and Benefits:

We offer many great benefits, including:

  • 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

Mercury Insurance is an equal opportunity employer.  All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, status as a protected veteran, or any other characteristic protected by federal, state, or local law.

Pay Range: USD $44,466.00 - USD $77,881.00 /Yr.

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