Associate PIP Claims Rep

This position is listed on behalf of a partner company, who manages all applications and next steps. Our partner is looking for an Associate PIP Claims Rep based in the United States.

This remote role supports the investigation, evaluation, negotiation, and resolution of Personal Injury Protection (PIP) and Medical Payments claims.
You will manage assigned claims across multiple states, navigating varying laws, regulations, and medical cost-containment requirements.
The role covers the full claims lifecycle, from verifying coverage and establishing reserves through investigation, settlement or denial, and file closure.
You will communicate with claimants and other stakeholders by phone, written correspondence, and other appropriate channels.
The position combines claims analysis, documentation, cost management, regulatory compliance, and customer service.
You will also coordinate medical experts and examinations when needed and identify potential subrogation opportunities.
This is an opportunity to build specialized claims expertise in a structured, compliance-focused environment.

• Receive and review assigned PIP and Medical Payments claims, verify coverage, and determine the appropriate course of action for claims up to $50,000.

• Set up and maintain claim files, establish initial reserves, and ensure all relevant information is accurately documented.

• Conduct claim investigations, analyze investigative findings, and determine appropriate claim handling strategies.

• Apply effective medical cost-containment strategies while evaluating claim expenses and incurred losses.

• Negotiate and settle eligible non-litigated claims or issue appropriate claim denials in accordance with established authority.

• Process payments, expenses, loss information, check requisitions, correspondence, and related claim documentation.

• Identify and investigate potential subrogation opportunities.

• Maintain control of assigned workloads through accurate documentation and diary management.

• Send checks, denial letters, and required reporting forms, and assist with departmental payments, correspondence, and telephone activities as needed.

• Assign medical or other qualified experts and arrange medical examinations when necessary.

• Ensure claims are handled consistently with applicable company procedures and state and federal laws and regulations.

• Communicate professionally with claimants, medical providers, experts, and other stakeholders throughout the claims process.

• Travel by automobile as needed, with expected car travel representing approximately 10% of working time.

Requirements:

• Minimum of 1 year of claims experience.

• Minimum of 1 year of data entry experience.

• Working knowledge of PIP laws, regulations, and medical cost-containment requirements across multiple states.

• Working knowledge of medical terminology.

• Ability to analyze claim information, evaluate documentation, and make sound decisions within established authority.

• Strong organizational skills and attention to detail for maintaining accurate claim files and managing multiple activities.

• Effective written and verbal communication skills for handling claim-related correspondence, telephone interactions, and negotiations.

• Ability to work independently while following established claims procedures, regulatory requirements, and performance standards.

• Comfortable working with claims and business software and maintaining accurate electronic records.

• College degree preferred.

• Valid state-issued driver's license in good standing and ability to drive an automobile.

• Ability to manage sensitive claim information professionally and maintain appropriate confidentiality.

Benefits:

• Salary range of $48,000–$73,000 per year, with actual compensation influenced by geographic location, qualifications, experience, skills, performance, and business needs.

• Competitive base salary.

• Eligibility for an incentive plan.

• Comprehensive healthcare plans.

• Retirement savings plan with company match.

• Discounted Employee Stock Purchase Program.

• Tuition assistance and reimbursement programs.

• 20 days of paid time off.

• Remote work opportunity within the United States.

• Total rewards designed to support health, financial well-being, and work-life balance.