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
Mercury Insurance has offered quality insurance for personal auto insurance to homeowners insurance to mechanical breakdown protection. It was founded in 1962, and is headquartered in Los Angeles, California, USA, with a workforce of 5001-10000 employees. Its website is http://www.mercuryinsurance.com.