Kentucky Farm Bureau Mutual Ins Co

Claim Representative - PIP Unit

US-KY-Louisville
2 weeks ago(1/2/2018 3:32 PM)
Job ID
2018-1180
# of Openings
1
Category
Claims

Overview

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The Claim Representative-PIP Unit handles no-fault claims from all claim offices within the state of Kentucky to ensure efficient and effective processing of Personal Injury Protection (PIP) benefits.

Responsibilities

 

ESSENTIAL FUNCTIONS

  • Accept assignment of PIP claims from claim adjusters.
  • Monitor continuing eligibility of PIP claimants.
  • Receive, investigate, coordinate, and pay appropriate PIP benefits in timely manner according to statute requirements.
  • Maintain proper reserves.
  • Process incoming and outgoing mail in regards to PIP Unit.
  • Create and type correspondence and issue form letters to investigate, resolve and responds to questions relating to PIP benefits.
  • Receive telephone and personal inquiries relating to PIP files by policyholders, customers, attorneys and medical providers, providing assistance where appropriate or referring to other staff if necessary.
  • Assure high customer satisfaction levels through professionalism, integrity, fairness and promptness.
  • Assist and cooperate with all company personnel.
  • Maintain PIP files to comply with statute requirements.
  • Monitor the claim inventory report to ensure proper closure of files.
  • Pursue professional development.
  • Report claims as required by claims manual or by district claims manager.
  • Serve as a catastrophe team member or assist in other claim offices or locations as required.
  • Regular, predictable attendance as employee has to physically be in the office.
  • This list of essential functions is non-exhaustive and may be supplemented as necessary.
  • OTHER RESPONSIBILITIES
  • .Establish companion PIP work file.
  • Secure appropriate PIP documents, i.e., medical reports, wage verifications, PIP applications. 
  • Obtain initial claim payment authority on each claimant from claim adjusters.
  • Diary all companion claim files to comply with statute requirements.
  • Furnish copy of PIP application, medical reports and wage verification to claim adjusters as requested.
  • Receive, investigate and pay medical bills, wage loss benefits, survivor's economic benefits, replacement service benefits and funeral expense benefits.
  • Maintain appropriate reserves for both basic and added reparation benefits.
  • Perform claim file maintenance transactions via terminal entry.
  • Receive and review loss reports on a regular basis from agents, claim adjusters and senior adjusters.
  • Establish claim files using data from loss reports.
  • Type letters and forms required to properly investigate and document payment of no             fault benefits.
  • Transmit recoveries to the Accounting Department on a timely basis.
  • Report claims as required by Claim Manual or by District Claims Manager.
  • Promptly respond to complaints as requested.
  • Report immediately the receipt of all summonses to PIP Unit Supervisor and handle as directed.
  • Review claim inventory reports monthly and make needed adjustments.
  • Make corrections on claim files as recommended by PIP Unit Supervisor or Team Lead following review.
  • Document claim files to support actions taken. (See claim manual)
  • May be called upon to handle first party claims and non-disputed liability claims.
  • May be called upon to assist on evaluation of inventory sheets for property loss claims.
  • Attend and participate in company meetings, seminars and other company sponsored educational activities at the request of the company.
  • May work a late Friday on a rotating basis to provide customer service to claims offices, agents and providers.
  • Attain the Certificate in General Insurance from Insurance Institute of America.
  • Maintain current knowledge of policy contracts and statute.
  • JOB SPECIFICATIONS
  • Physical demands: Normal vision/hearing with or without correction; Sitting.
  • Mental demands: Analytic reasoning; Prolonged concentration.
  • Environmental factors: Standard office lighting, temperature, and noise.
  • Equipment: Keyboard; Telephone; Calculator; Copier/Fax.

Qualifications

QUALIFICATIONS

  • Associate degree or combination of formal education, training, and experience to acquire knowledge and skills generally equivalent to those possessed by a two-year college graduate. Bachelor’s degree preferred.
  • Required to obtain an Adjuster License within one year of hire date.
  • Previous experience in a claims or insurance office desirable.
  • Average typing skill (minimum 35 wpm).
  • Knowledge of claims handling procedures and insurance contracts.
  • Experience in the use of photocopier, computer terminal or word processor and other office equipment.
  • Ability to communicate with high level of skill both orally and in writing.
  • Ability to make timely decisions.
  • Excellent human relation skills and self-motivation required.
  • Ability to act in a confidential manner.
  • Knowledge of word processing software.

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