Claims PIP Manager

RESPONSIBILITIES

• Directly supervises a team of PIP and/or PIP Demand Adjusters ensuring losses are handled in a professional and prompt manner and that specified goals are met.
• Provides direction to PIP team on all aspects of claims handling and claims supervision.
• Reviews and evaluates the file-handling process to meet company and statutory guidelines.
• Coordinates the investigation process with other units and outside vendors as required.
• Identifies potential for subrogation and refers claims to the subrogation group as appropriate.
• Identifies potential fraud and makes referrals to the special investigation unit (SIU) as appropriate.
• Reviews coverage based on the policy and jurisdiction.
• Receives, approves, or denies medical payments.
• Documents activity on claim files.
• Mentors and coaches team members to develop skills, increase job knowledge and achieve stated performance objectives.
• Updates the PIP Director on trends and unusual claim activity.
• Ensures consistent delivery of services that meets or exceeds customer expectations and complies with regulatory and company standards.
• Responsible for team performance management and evaluations.
• Performs other related duties as assigned.

JOB REQUIREMENTS

• A 2-year degree or higher related to the insurance field is highly desirable; high school diploma or equivalency required.
• A minimum of 5 years of experience handling Florida PIP claims including responding to pre-suit demands.
• Minimum of 2 years of leadership experience within the auto insurance claims industry preferred.
• Thorough knowledge of claims investigation techniques, as well as medical and legal aspects of claims.
• Knowledge of the No-Fault auto insurance policy and Florida No-Fault Statute.
• A solid understanding of the claims policies and procedures in resolving pre-suit PIP demands.
• Strategic-minded, and deeply committed to employee development and morale within a high-performance environment.
• Medical terminology, medical coding and ICD9/10 experience preferred.
• Ability to read, analyze, comprehend, and disseminate information from medical documents.
• Ability to effectively perform in a fast-paced environment while managing multiple priorities simultaneously with a high degree of detail.
• Ability to deal with dynamic situations, to be able to modify plans, actions, and decisions in light of changing situations and circumstances.
• Exceptional customer service and teamwork philosophy. Excellent verbal & written communication skills.
• Above average computer skills with various industry software knowledge a plus; ability to use Microsoft Office Suite products.
• Must currently hold or have the ability to secure and maintain Florida adjuster license(s) within 60 days of employment.

PHYSICAL DEMANDS: The physical demands described here are representative of those that must be met by an employee to perform the essential functions of this job successfully. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. While performing the duties of this job, the employee is regularly required to do manual tasks, which may include the use of hands to finger and handle controls. Tasks may also require the ability to talk or hear. The employee will frequently sit, bend, and reach with hands and arms and is occasionally required to stand and walk. The employee may occasionally lift and/or move up to 10 pounds. Specific vision abilities required by this job include close vision, color vision, and the ability to adjust focus. Other abilities include possessing the capacity to learn, concentrate, think, and read. Oftentimes the employee will be communicating and interacting with others while working.

To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed are representative of the knowledge, skill, and/or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. This job description in no way states or implies that these are the only duties to be performed by the employee(s) incumbent in this position. Employee(s) will be required to follow any other job-related instructions and perform any other job-related duties requested by anyone authorized to give instructions or assignments.