- Handles medical payments and or PIP/no-fault claims. Investigate origin and cause of claims by contacting the appropriate parties including insureds, claimants, agents, attorneys, contractors, experts, special investigation unit, other adjusters, public personnel, etc. Ensures compliance with state and company procedures and timeframes and maintains adequate and accurate reserves. Elevates payments, reserves and coverage determinations outside authority to management.
- Provides exceptional customer service by assisting customers throughout the 1st party medical claims process. This includes but is not limited to: explaining the applicable benefits, eligibility, required forms and procedures, providing claim status updates and information through both verbal and written communications and issuing timely and accurate reimbursement of medical, wage loss, and other benefits available under the policy.
- Responsible for obtaining, analyzing, adjusting and processing timely and accurate payments on medical bills within prescribed authority. Bill analysis will include: reviewing medical records and codes for reasonableness, relatedness and duplicate charges, reviewing compliance with applicable fee schedules, ensuring accuracy in application of applicable co-pays and deductibles, coordinating and reviewing results of independent medical examinations and peer reviews and making claim handling recommendations.
- Identify complex issues and finds assistance as needed. Handle claims on a good faith basis.
- Handles both 1st party and 3rd party claims under multiple policy types and numerous endorsements.
- Evaluates damages, and handles claim negotiations with insureds, claimants, attorneys, public adjusters.
- Respond to customer inquiries, makes appropriate decisions and close file as needed.
- Interpret and determine policies, leases, by-laws, declarations, articles and contract coverages and applies to all parties for assigned losses.
- Provides all parties with claim process and status as appropriate; answers questions or redirects to other areas.
- One or more years of PIP experience
- Current active adjuster's license
- New York, Florida, and/or Pennsylvania state-handling experience
- Mitchell Decision Point software experience preferred
- SIU knowledge preferred
- Demonstrated experience providing customer-driven solutions, support, or service.
- Demonstrated experience handling 1st and 3rd party, multi-line claims across our operating territories, or other equivalent experience.
- Demonstrated experience handling moderately complex claims, or other equivalent experience.
- Solid knowledge and understanding of policies and endorsements related to casualty coverages, or other equivalent knowledge.
- Solid knowledge and understanding of each phase of the claim handling process, or other equivalent knowledge.
- Obtain state specific property casualty claims licensing as required.
- Up to 10%.
- Work that primarily involves sitting/standing.
- Offer to selected candidate will be made contingent on the results of applicable background checks.
- Offer to selected candidate is contingent on signing a non-disclosure agreement for proprietary information, trade secrets, and inventions.
- Our policy restricts consideration of applicants needing employment sponsorship (visa) to specialty occupations. Sponsorship will not be considered for this position.
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PIP and Med Pay Claims Adjuster - Nashville, United States - The General
Description
Investigate and maintain personal injury protection (PIP) and medical payment claims in multiple sates in accordance with state rules and regulations. Determine liability, secures information, reviews coverages, arranges appraisals, and settles claims. You will primarily work from home and will report to the Med/PIP Adjuster Services Manager.Position Compensation Range:
$55, $90,000.00Pay Rate Type:
SalaryPrimary Accountabilities
Qualifications
Specialized Knowledge & Skills Requirements
Licenses
Travel Requirements
Physical Requirements
Location
In this primarily home-based role, you will spend 80% of your time (4+ days per week) working from home, proximate to one of our office locations (within approximately 35-50 miles): Madison, WI 53783; Boston, MA 02110; Atlanta, GA metro area; Denver, CO 80112; Eden Prairie, MN 55343; Keene, NH 03431; St. Joseph, MO 64507; Phoenix, AZ 85034; Nashville, TN 37214.
On occasion you may be asked to travel to an office location for in person engagement activities such as team meetings, trainings, and culture events.
Internal candidates are encouraged to apply regardless of location and will be considered based upon the needs of the role.
#LI-Remote
We encourage you to apply even if you do not meet all of the requirements listed above. Skills can be used in many different ways, and your life and professional experience may be relevant beyond what a list of requirements will capture. We encourage those who are passionate about what we do to apply
We provide benefits that support your physical, emotional, and financial wellbeing. You will have access to comprehensive medical, dental, vision and wellbeing benefits that enable you to take care of your health. We also offer a competitive 401(k) contribution, a pension plan, an annual incentive, 9 paid holidays and a paid time off program (23 days accrued annually for full-time employees). In addition, our student loan repayment program and paid-family leave are available to support our employees and their families. Interns and contingent workers are not eligible for American Family Insurance Group benefits.
We are an equal opportunity employer. It is our policy to comply with all applicable federal, state and local laws pertaining to non-discrimination, non-harassment and equal opportunity. We also consider qualified applicants with criminal histories, consistent with applicable federal, state and local law.
#LI-CW1
