PIP Claims Representative

Receive assigned Personal Injury Protection claims, verify coverage, and confirm eligibility to determine the course of action. Conduct detailed investigations via telephone and written correspondence with subscribers, attorneys, and witnesses to evaluate claim exposure and establish proper reserves. Analyze medical necessity and causal relationships by assigning case managers and arranging independent medical examinations when required. Handle incoming inquiries from claimants and providers while documenting files and maintaining a diary system for follow-up. Manage allocated loss adjustment expenses and direct outside vendors as needed. Ensure all dispositions comply with company policies, regulatory requirements, and the Unfair Claim Practices Acts. Collaborate with the Special Investigation Unit, underwriting, and legal teams to achieve optimum results.