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Plymouth Rock Assurance NY Anti-Fraud Specialist, PIP in Uniondale, New York

Plymouth Rock has been awarded the #1 Large Employer in New Jersey in 2021. We would love for you to join our award winning team!

This position is responsible for applying knowledge and experience to our claim processes, data analytics and investigations. The specialist will be responsible for in-depth investigation of New York No Fault claims with a focus on treatment patterns, practices, and assessment of damages. This position will be based out of the Woodbridge, New Jersey office.

Essential Functions and Responsibilities:

  • Daily duties include first reports, mail tasks, medical bill review, treatment monitoring, and reserve assessment.

  • Thoroughly screen all injured parties, investigate new losses in compliance with defined procedures and establish appropriate claims.

  • Conduct thorough and prompt investigations of accidents recognizing SIU Fraud Indicators and Subrogation potential.

  • Maintains an effective follow-up system on pending files, prioritize and handle multiple tasks simultaneously, adjust to fluctuating workload, advises injured parties as to the status of the claim. Assure that voice mail is properly utilized and telephone messages are promptly returned.

  • Investigates and interprets policy provisions and conditions to make a coverage determination.

  • Functional knowledge of medical terminology and anatomy with a thorough understanding of Personal Injury Protection claim handling regulatory requirements is preferred.

  • Analytical and problem solving skills to use and interpret information and facts as well as apply critical techniques to investigative process.

  • Complete investigations addressing all medical related services and provide recommendation for claim handling based upon findings.

  • Proven ability to acquire, analyze and interpret information from various data sources and formulate theories regarding trends and patterns required.

  • The ability to identify trends and common indicators within particular claims and territories and determine if further investigation is warranted.

  • Collaborate with others in developing visual analytics to support complex investigation data involving multiple claims and multiple entities.

  • Ability to interface with outside defense counsel on a frequent basis to develop and execute upon action plans

Education and Experience:

  • A Bachelor’s degree from an accredited four-year college or university is a plus.

  • 2-5 years of Personal Injury Protection claims handling / No Fault claims handling experience

  • Strong Computer skills including Microsoft Office suit, (Word, PowerPoint, Excel, Outlook)

  • Strong verbal and writing skills.

  • The ability to manage and analyze large volumes of data from various internal and external sources and develop recommendations.

  • The ability to read and interpret complex information and explain it to others; listen actively, stay focused, identify hidden messages and draw out underlying issues.

  • Organizational skills with the ability to organize data in manageable subsets and the ability to get requests completed timely and accurately.

  • Advanced proficiency with Microsoft: Excel, Access and Visio. Tableau and SQL knowledge would also be preferred.

  • Ability to analyze information secured during routine claims investigation and present information with recommended outcome.

  • Ability to multi-task to ensure compliance with State compliance standards.

  • Able to prioritize and handle multiple tasks while adjusting to fluctuating workload.

About the Company

The Plymouth Rock Company and its affiliated group of companies write and manage over $1.6 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 1,900 people and is headquartered in Boston, Massachusetts. Plymouth Rock Assurance Corporation holds an A.M. Best rating of “A-/Excellent”.

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Job ID: 2023-3727

External Company URL: www.prac.com/

Street: 50 Charles Lindbergh Boulevard Suite 401

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