Claims Customer Service First Party Medical

Claims Customer Service First Party Medical:

CURE Auto Insurance is a leading direct writer of auto insurance in New Jersey, Pennsylvania, and Michigan. CURE offers a great working environment, competitive salary, and comprehensive benefits package which includes health and dental coverage, life and disability insurance, 401k with generous company match, and much more!

The Claims Customer Service First Party Medical will handle the investigation, evaluation and disposition by settlement, payment, or denial of complex Personal Injury Protection claims. Ensure that claims are processed within company policies, procedures, regulatory requirements, and the individual's prescribed authority with high standards of performance.

Essential Job Functions

● Receive assigned claims, verify coverage, confirm eligibility and determine course of action.

● Complete detailed, thorough claim investigation through telephone and/or written correspondence with subscribers, attorneys, witnesses and any others with information relevant to the claim.

● Analyze information obtained through investigation in order to evaluate the claim, determine PIP eligibility and determine the extent of the injuries and claim exposure.

● Establish and maintain the proper reserves for the exposure.

● Assign medical case managers or other experts to a case when appropriate and arrange for independent medical examinations when necessary to determine medical necessity and causal relationship of treatment.

● Handle incoming calls and correspondence from subscribers, claimants, attorneys and providers regarding questions or problems associated with a claim.

● Document claim files and maintain a diary system for reporting and claim follow-up.

● Handle claims in accordance with CURE's Decision Point Review Plan.

● Work closely with the Special Investigation Unit, Underwriting Department, attorneys, and other members of the Claim Department to ensure that CURE achieves optimum results on all files.

● Manages allocated loss adjustment expense. Employs outside vendors when activities cannot be completed by a staff member and directs the activities of vendors to ensure only necessary work is completed

● Comply with all conditions outlined in the Unfair Claim Practices Acts.

● Perform other duties as assigned.

Requirements

● Education: Bachelor's degree or commensurate experience in the insurance industry or customer service

● Years/Type of Experience: A minimum of 2 years customer service or commensurate medical experience preferred.

● Specific Skills: Must have excellent customer service skills; the ability to multitask, analyze coverages, liability and damages.

● Other Required or Preferred Qualifications: Detail oriented with strong written and verbal communication skills. Must be able to work independently as well as possess strong interpersonal skills necessary to contribute as a team player.

Benefits:

● Comprehensive health benefits including medical, dental and vision coverage

● Generous paid time off (PTO days, sick days, and holidays)

● Flexible spending options with FSA & HSA plans

● Life and AD&D insurance

● 401(k) with company match

● Voluntary benefits such as legal services, pet insurance, and identity & fraud protection

● 24/7 Employee Assistance Program (EAP) for employees and their families

● Health & wellness perks including gym discounts, wellness reimbursements, and reward programs

● Fun, engaging in-office events that support our culture

Starting Salary: $58,240 - $76,960

Schedule: We offer flexible work hours between 8:00 AM and 5:00 PM, and employees can choose a schedule that works best for them—8:00 AM–4:00 PM, 8:30 AM–4:30 PM, or 9:00AM–5:00 PM. While we aim to support individual preferences, final schedules may be adjusted based on business needs to ensure great coverage and teamwork. 

We offer a hybrid work schedule: team members work onsite 4 days per week and have the flexibility to work remotely 1 day per week.

Location: Detroit, MI or Princeton, NJ

We recruit, hire, employ, train and promote, and compensate individuals based on job-related qualifications and abilities. We respect the dignity and worth of each individual and are committed to an employment environment that is free from all forms of employment discrimination.

CURE Auto Insurance provides equal employment opportunities to all employees and applicants for employment and prohibits discrimination and harassment of any type without regard to race, color, religion, age, sex, national origin, disability status, genetics, protected veteran status, sexual orientation, pregnancy, gender identity or expression, or any other characteristic protected by federal, state or local laws. This policy applies to all terms and conditions of employment, including recruiting, hiring, placement, promotion, termination, layoff, recall, transfer, leaves of absence, compensation and training.

Disclaimer: This job description reflects management's assignment of essential functions; it does not prescribe or restrict the tasks that may be assigned. This job description may be subject to change at any time. Applicants must be authorized to work for ANY employer in the U.S. We are unable to sponsor or take over sponsorship of an employment Visa at this time.