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Mercury Insurance

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Claims Specialist II, PIP

Claims SpecialistClaims SpecialistFull TimeRemoteJuniorTeam 5,001-10,000Since 1962H1B SponsorCompany SiteLinkedIn

Location

United States

Posted

86 days ago

Salary

$44.5K - $77.9K / year

Seniority

Junior

High School0.5 yrs expExperience acceptedEnglish

Job Description

Claims Specialist II, PIP

Mercury Insurance

• The primary job function is to investigate and manage Personal Injury Protection (PIP) Claims. • 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.

Job Requirements

  • 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
  • Minimum: At least 6 months of related experience
  • Or equivalent combination of education and experience
  • 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.
  • 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.

Benefits

  • 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

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