Bristol West Claims Medpip Rep (Hybrid - Grand Rapids or Kansas City)

Job Summary

A Bristol West Med Pay/PIP (Personal Injury Protection) representative conducts claims investigations, coverage confirmation, establishes appropriate medical necessity and payment of claims settlement. Using claims systems to accurately document files, they manage a diary and handle first party medical claims promptly, proactively and with a sense of urgency. 

• Target Start Dates: 
• Unlicensed: February 23rd, 2026.
• Licensed: March 9th 2026.
• Compensation: $52,000 - $70,000. Compensation is determined by a number of factors including skills and experience and may vary based on the job level and your geographic location. 
• Locations: This is a Hybrid role and candidates must be located near our Grand Rapids, MI or Kansas City, KS Hubs. 
• Kansas City: 10200 Abilities Way, Suite 800, Kansas City, KS 66111 
• Grand Rapids: 5665 N Kraft Lake Drive, Caledonia, MI 49316 
• Workplace: Hybrid 
• Schedule: Monday-Friday 8am-5pm local time 

Essential Job Functions

• Evaluates Personal Injury Protection (PIP) and Med Pay claims for eligibility, medical necessity, and appropriateness of charges in accordance with state fee schedules.
• Determines relatedness, causation, and appropriateness of treatment based on the compensable injury.
• Provides reserve recommendations and makes payment approval to ensure activities are consistent with corporate policies.
• Conducts detail bill reviews and process claims within designated authority levels.
• Makes contacts with stakeholders to investigate and process claims.
• Contacts may include multiple attempts to communicate with various parties and requires telephone conversations or other methods of communication to be a priority.
• Parties involved could include policy holders, claimants, agents, witnesses, contractors, police and fire departments, state and county fraud and arson personnel, special investigators, attorneys, expert witnesses, members of the medical profession and other persons pertaining to the investigation and processing of claims.
• Performs other duties as assigned.

Experience Requirements

• Less than one year of Insurance industry or related experience preferred.

Special Skill Requirement

• Strong verbal communication and listening skills. Strong written communication skills with the ability to convey critical decisions and information through written letters.
• Demonstrates excellent judgment and decision-making skills.
• Effective negotiation skills.
• Possesses flexibility to work in a fast-paced, dynamic environment; uses discretion to modify work practices and processes to achieve results or improve efficiency.
• Demonstrated problem-solving skills. Takes a broad perspective on problems and spots new, less obvious solutions.
• Performs work independently with minimal supervision.
• Possesses strong technical aptitude; Proficient in Microsoft Office products. Adaptable and flexible to new technology.
• Effective conflict management skills. Identifies key issues and patterns from partial/conflicting data.
• Strong skills in multi tasking and working with a sense of urgency 

Education Requirements

• High school diploma or equivalent required.
• Bachelor’s degree preferred.

Physical Actions

• This role, whether performed virtually or in an office setting, will include normal and customary distractions, noise, and interruptions.
• Sits or stands for extended periods of time, up to a full work shift.
• Occasionally reaches overhead and below the knees, including bending, twisting, pulling, and stooping.
• Occasionally moves, lifts, carries, and places objects and supplies weighing 0-10 pounds without assistance.
• Listens to, interprets, and differentiates auditory information (example others speaking) at normal speaking levels with or without correction.
• Visually verifies and reads information.
• Visually locates material, resources and other objects.
• Ability to continuously operate a computer for extended periods of time, up to a full work shift.
• Physical dexterity sufficient to use hands, arms, and shoulders repetitively to operate keyboard and other office equipment up to a full work shift.

Physical Environment

• This position operates in an open office working environment which will include normal and customary distractions, noise, and interruptions.