PIP Adjuster

First Acceptance•Marianna, FL

3d•Onsite

About The Position

The PIP Adjuster is responsible for managing claim files from receipt to settlement. This role involves analyzing various types of claims, including medical bills and lost wages, ensuring all necessary information is gathered, and authorizing payments within company guidelines. The position requires maintaining up-to-date knowledge of claims procedures, regulations, and policy changes. Additionally, the PIP Adjuster will investigate potential fraud, evaluate exposures for No-fault and Medpay losses, and handle all incoming and outgoing correspondence, including phone calls and written communications. The role also involves thorough documentation of injury-related treatment and expenses, and performing other assigned duties.

Requirements

High school diploma or equivalency is required.
A minimum of 2 years of relevant claims, insurance or other administrative experience is required.
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.

Nice To Haves

A 2-year degree or higher in a related field is highly desirable.
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.

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.