Mercury Insurance

Claims Specialist II, PIP

Mercury Insurance

full-time

Posted on:

Location Type: Remote

Location: United States

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Salary

💰 $44,466 - $77,881 per year

Job Level

Junior

About the role

  • 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.

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
Applicant Tracking System Keywords

Tip: use these terms in your resume and cover letter to boost ATS matches.

Hard Skills & Tools
medical terminologymedical codingCPT codingICD-10 codingclaims managementclaims evaluationclaims settlement procedurescoverage verificationinjury analysiswage loss assessment
Soft Skills
sound judgmentcustomer servicewritten communicationverbal communicationcollaborationemotional intelligenceconflict resolutionself-motivationaccountabilityorganizational skills
Certifications
High School DiplomaGEDAdjuster’s license