Claims Representative - PIP/MPCAt Metromile
On the off chance you've thought about insurance, it's likely because you've insured something you love, not because you loved your insurance company. Metromile is out to change that. As an insurtech powered by data science and customer centric-design, we’re building a community of drivers who come for the savings and stay for the experience.
With technology at its core, Metromile is reimagining insurance to make it fairer and actually delightful. We’re obsessed with savings, service, and features -- street sweeping alerts, monthly mileage summaries, fuel trackers and more -- that engage a customer all along their journey. We’re on the forefront of disrupting a $250 billion auto insurance category that has gone unchanged for over 80 years.
Metromile’s diverse team combines the best of Silicon Valley technologists with veterans from Fortune 500 insurers and financial services giants. This management structure ensures that the business is focused on growth, customer experience and technology innovation while also balancing unit economics and profitability. The team is growing quickly across its San Francisco, Tempe, and Boston offices. Our customer service, claims, and sales teams are all based in-house in the US.
Thanks to what makes us different -- our people and our technology -- we’ve been honored with a slew of awards. A few recent ones include: named a Benzinga “Best Insurtech” finalist, a Top Company to Work For, one of the Healthiest Employers in Phoenix, and a Best Place to Work. And, our CEO was recognized as a 2020 40 under 40.
About the role
**This role can be 100% remote**
As a Personal Injury Protection (PIP) Claims Representative you will be directly involved in helping us create and develop our PIP handling guidelines. You will also be responsible for investigating, evaluating, and resolving PIP claims including complex claims in multiple states.
- Investigate, manages, evaluates and resolves claims assigned by Claims Team Manager. Evaluates medical necessity, subrogation potential and handle claims within prescribed authority.
- Communicates with policyholders, attorneys, medical providers, and managed care vendors in order to gather information regarding claims and refers tasks to third party vendors as necessary. Responds to various telephone and electronic communications .
- Reviews medical records and bills to verify claimed treatment is causally related to the accident and is reasonable and necessary given facts of the claim.
- Ensures adequacy of reserves and payment authority.
- Confirms or denies coverage and advises policyholders, attorneys and claimants as to proper course of action.
- Makes effective use of loss management techniques (IMEs, Nurse Review, and Bill Review). Negotiates settlements with attorneys, claimants, and medical providers. Arranges for expert inspections involving third party or potential fraud actions as needed.
- Updates files and provides comprehensive reports as required.
- Identifies and recommends referral of potentially fraudulent claims to the Special Investigation Unit.
- Recognizes continuous improvement opportunities and develops
- 4+ years of PIP experience from an auto insurance carrier
- Auto Managed Car/Provider network experience
- Excellent verbal and written communication skills
- Self-managed, highly motivated, and confident
- Able to work well under deadlines in a high-paced, changing environment
- Analytical mindset and problem-solving skills
- Attention to detail
- Bachelor’s Degree preferred but not required or equivalent experience required
What’s in it for you
- Competitive salary
- Restricted stock units for every employee
- Excellent benefit package (health, dental, vision, 401K with match)
- Well-being reimbursement, includes home office equipment
- Flexible paid vacation program
- Flexible scheduling/hours
- Remote work options
- 13 paid holidays - 2 of which are flex
- 12 paid weeks of leave for child birth/adoption
- Annual anniversary gifts (5 yr. - 6 week paid sabbatical)
If you got to this point, we hope you're feeling excited about the role. Even if you don't feel that you meet every single requirement, we still encourage you to apply. We're eager to meet people that believe in Metromile’s mission and can contribute to our team in a variety of ways – not just candidates who check all the boxes.
Metromile is committed to building a diverse, inclusive and equitable culture at all levels. We nurture a sense of community by investing in one another’s unique backgrounds and experiences to drive business success and positively influence our services and products.
Metromile is proud to be an equal opportunity employer. We will not discriminate against any applicant or employee on the basis of age, race, color, ethnicity, national origin, citizenship, religion, creed, sex, sexual orientation, gender, gender identity or expression (including against any individual that is transitioning, has transitioned, or is perceived to be transitioning), marital status or civil partnership/union status, physical or mental disability, medical condition, pregnancy, childbirth, genetic information, military and veteran status, or any other basis prohibited by applicable federal, state or local law.
If you are offered a position with Metromile, Inc. you will be required to successfully complete a background check. Metromile reserves the right to seek clarification of any alerts regarding your background check in order to confirm eligibility for employment.