Claims PIP Adjuster

First Acceptance Insurance

83d

About The Position

As a member of the Claims team, the PIP Adjuster is primarily responsible for claims management and processing, as well as other assigned claim administration tasks. This includes review, analysis, and settlement of first party medical claims consistent with company guidelines.

Requirements

• A 2-year degree or higher in a related field is highly desirable; high school diploma or equivalency is required.
• A minimum of 2 years of relevant claims, insurance or other administrative experience is required.
• Knowledge of medical and legal terminology a plus.
• Must currently hold or have the ability to secure and maintain Florida adjuster license(s) within 60 days of employment.
• Strong customer service skills and related behaviors are required.
• Requires the ability to multi-task.
• Strong analytical and problem-solving skills.
• Excellent interpersonal and communication skills.
• Effective organizational and time management skills.
• Ability to work in a fast-paced environment with attention to detail and deadlines.
• Proficient in Microsoft Suite (i.e., Word, Excel, PowerPoint, etc.).
• Requires computer literacy and the ability to learn software applications.
• Commitment to First Acceptance’s company values.

Responsibilities

• Receives and responds to correspondence regarding claim files in a timely manner.
• Identifies involved parties eligible for coverage; analyzes medical bill(s), lost wages, and/or other expense claims submitted for payment using a consistent and thorough review process.
• Follows-up on claims to ensure all pertinent information is received to settle claims.
• Authorizes payment of claims within company guidelines.
• Maintains current knowledge of new claim settlement procedures, state regulations, and policy changes.
• Develops a comprehensive settlement strategy; utilizes appropriate medical, wage, and/or other expense claim investigation forms and form letters.
• Maintains compliance with Standard Operating Procedures, Regulatory and Statutory requirements, and/or best practices.
• Identifies potential fraud indicators and works closely with the Special Investigations Unit (SIU) when appropriate.
• Investigates No-fault and Medpay losses; evaluates exposures.
• Processes incoming mail and data through various systems and software.
• Completes incoming and outgoing phone calls, taking recorded statements when appropriate; composes written correspondence.
• Thoroughly documents injury related treatment, lost wages, and/or other expense history.
• Performs other duties as assigned.

Benefits

• Health Insurance
• Dental
• Vision
• Paid Vacation
• Disability Insurance
• Employer Matching 401(k) Program

What This Job Offers

• Job Type: Full-time
• Career Level: Entry Level
• Education Level: Associate degree
• Number of Employees: 501-1,000 employees