PIP Specialist

Our specialists are responsible for the investigation, valuation, establishment of exposure, negotiation and settlement of assigned No-fault and Med pay claims within a stipulated monetary authority . Ensures that all assigned claims are concluded promptly, equitably and economically within the provisions of the policy contract and in accordance with the damages presented. Since this is an entry level position, the incumbent works with minimal authority under the direct supervision of a Unit Manager and the Manager of Training.

Position Responsibilities:

• Medical Claims Handling: Identify involved parties eligible for coverage, analyze medical bill, lost wage and other expense claims submitted for payment using a consistent and thorough review process. Establish accurate loss, and when applicable, expense and subrogation reserves relative to the damages assessed. Research and interpret injury related statutory provisions and case law; examine points of impact and extent of damage relative to the injury claimed; access prior injury information; develop and maintain rapport with the claimant or claimant’s representative. Obtain proper release documentation; obtain detailed medical report, medical bill, wage and other expense information and conduct detailed research relating to damages submitted for payment. Utilize IME and Peer Review processes when appropriate; take applicable offsets when appropriate. Thoroughly document injury related treatment, lost wage and other expense history and develop a comprehensive settlement strategy; utilize appropriate medical, wage and other expense claim investigation forms and form letters. Compliance with Standard Operating Procedures, Regulatory and Statutory requirements and/or Best Practices in the processing of all claims.

• Claims Administration and Investigation: Obtain and analyze loss details and develop a comprehensive strategy to efficiently and accurately reach resolution on claims presented for coverage. Keep all customers and relevant representatives informed of the claims process and claim status using professional written and verbal communications. Examine insurance policy provisions, endorsements, state statutory provisions and other records to verify applicable coverage. Systematically research and resolve coverage issues identified during the coverage investigation. Conduct liability investigations utilizing investigative tools and processes to include obtaining recorded statements from involved parties, interpreting and decoding police reports, analyzing scene investigations and expert reports and interpreting state negligence laws, statutory provisions and case law. Maintain a current diary on all claims. Thoroughly and accurately document the progression of each claim.

• Communications and Customer Service: Exhibit effective verbal and written communication; deliver clear, timely messages that are easily understood. Demonstrate an awareness of different communication styles and express appropriate levels of empathy and sensitivity in communications. Anticipate customer needs, communicate decisions, define expectations and fulfill commitments to involved parties. Develop and implement negotiation strategies when communicating settlement related information to insured’s, claimants, attorneys, medical providers and other parties.

• Claims Fraud Identification and Prevention: Partner with SIU to identify red flags, and when appropriate, referral criteria and referral guidelines. Investigate coverage and loss details to identify incidents of misrepresentation and suspicious patterns or activities. Conduct appropriate analyses, obtain needed information and follow Standard Operating Procedures and appropriate guidelines to ensure effective and efficient resolution of claim.

• Litigation Claims Handling: Work closely with the Litigation Manager and/or Director and defense attorney, when applicable, to respond timely, accurately and professionally to plaintiff representative’s verbal and written correspondence. Establish accurate loss and expense reserves; develop a comprehensive settlement strategy and complete lawsuit, supplemental lawsuit and closed lawsuit reports. Research, interpret and communicate to appropriate team members applicable case law related to property damage and bodily injury related claims. Work closely with Litigation Manager and/or Director to handle first party coverage issues, accurately research, interpret and utilize applicable legal terminology, cause(s) of action, jurisdictional issues, pleadings and procedures, and discovery tools. Understand and document litigation stages, litigation strategies and litigation cost control measures. Consider alternative dispute resolution methods when applicable.

Position Qualifications:

• Candidates must have a high school degree with a 1 year full time work experience after graduation. A 4 year college degree is preferred.
• Must have good computer skills.
• Must have good planning and organizing skills.
• Must have excellent written and verbal communication skills. Some positions may require specific bilingual skills.
• Must have the ability to deal with conflict.

Kemper is proud to be an equal opportunity employer. All applicants will be considered for employment without attention to race, color, religion, sex, sexual orientation, gender identity, national origin, veteran, disability status or any other status protected by the laws or regulations in the locations where we operate. We are committed to supporting diversity and equality across our organization and we work diligently to maintain a workplace free from discrimination.

Kemper does not accept unsolicited resumes through or from search firms or staffing agencies. All unsolicited resumes will be considered the property of Kemper and Kemper will not be obligated to pay a placement fee.