Administrative Claims Specialist, PIP

The Administrative Claims Specialist is responsible for supporting the company's Medical Claims Operation located in Woodbridge, NJ. The candidate should be flexible to perform multiple job functions as requested in a high paced environment.

Essential Functions and Responsibilities

• Review accuracy in billing, pre-certification compliance with our Medical Management Departments' decisions, and the re-pricing of the medical bills

• Review of physician medical records to ensure proper coding was utilized

• Applicable report generation and distribution

• Comply with all safety policies, practices and procedures. Report all unsafe activities to supervisor and/or Human Resources.

• Participate in proactive team efforts to achieve departmental and company goals.

• Perform other duties as assigned to support the various units within the claims department

• Provide support on Provider Service Phone Unit and/or Medical Portal

• Ability to use all available applications to answer customer calls, within our guidelines

• Manual entry of medical bills in a paperless environment using multiple software applications and dual monitors.

• Keying of checks including payroll, interest, etc.

Qualifications and Education

• High School Diploma or GED equivalent required; College preferred but not necessary

• Ability to establish and maintain positive and effective work relationships with coworkers, providers, and customers

• Ability to participate in a teamwork approach to accomplish tasks

• Ability to handle multiple tasks simultaneously

• Demonstrate effective verbal and written communication skills

• Knowledge of Microsoft Office products (Word, Excel, Outlook)

• Knowledge of CPT coding guidelines, medical terminology, anatomy and physiology helpful but not necessary

• Knowledge of the NJ PIP Fee Schedule, CMS/Medicare, NCCI, AMA helpful but not necessary

About the Company

The Plymouth Rock Company and its affiliated group of companies write and manage over $2 billion in personal and commercial auto and homeowner's insurance throughout the Northeast and mid-Atlantic, where we have built an unparalleled reputation for service. We continuously invest in technology, our employees thrive in our empowering environment, and our customers are among the most loyal in the industry. The Plymouth Rock group of companies employs more than 1,800 people and is headquartered in Boston, Massachusetts. Plymouth Rock Assurance Corporation holds an A.M. Best rating of "A-/Excellent".