[Remote] Claims Specialist II PIP

Note: The job is a remote job and is open to candidates in USA. Mercury Insurance is a company dedicated to helping people reduce risk and overcome unexpected events. They are seeking a Claims Specialist II to investigate and manage Personal Injury Protection (PIP) claims, ensuring proper coverage and claims processing.

Responsibilities

• 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

Skills

• 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
• At least 6 months of related experience
• Or equivalent combination of education and experience
• 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
• Must have dedicated workspace that is free from distractions
• Bachelor's Degree
• 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

Company Overview