PIP Adjuster

First Acceptance•Marianna, FL

About The Position

The PIP Adjuster investigates No-fault and Medpay losses, evaluates exposures, reviews claims for medical bills, lost wages, and other expenses, and authorizes payments within company guidelines. The role involves maintaining timely communication with claimants and other parties, collecting information needed to settle claims, developing settlement strategies, and documenting injury-related treatment, wage losses, and other expenses. The adjuster also processes mail and claim data using various systems and software, makes and receives calls, takes recorded statements when appropriate, and prepares written correspondence. The position requires compliance with company procedures, regulatory and statutory requirements, and applicable best practices. The adjuster maintains knowledge of claim-settlement procedures, state regulations, and policy changes, identifies potential fraud indicators, and works with the Special Investigations Unit when appropriate. Other duties may be assigned.

Requirements

High school diploma or equivalency required.
At least 2 years of relevant claims, insurance, or other administrative experience required.
Must hold or be able to secure and maintain Florida adjuster license(s) within 60 days of employment.
Strong customer service skills and related behaviors.
Ability to multitask.
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 while maintaining attention to detail and deadlines.
Proficiency in Microsoft Suite, including Word, Excel, and PowerPoint.
Computer literacy and ability to learn software applications.
Commitment to First Acceptance’s company values.
Ability to perform the essential functions of the job, with reasonable accommodations where applicable.

Nice To Haves

A 2-year degree or higher in a related field is highly desirable.
Knowledge of medical and legal terminology.

Responsibilities

Respond to correspondence regarding claim files in a timely manner.
Identify parties eligible for coverage and review medical bills, lost wages, and other expense claims submitted for payment.
Follow up on claims to obtain pertinent information needed for settlement.
Authorize claim payments within company guidelines.
Maintain current knowledge of claim settlement procedures, state regulations, and policy changes.
Develop settlement strategies and use appropriate investigation forms and form letters for medical, wage, and other expense claims.
Comply with Standard Operating Procedures, regulatory and statutory requirements, and best practices.
Identify potential fraud indicators and work with the Special Investigations Unit when appropriate.
Investigate No-fault and Medpay losses and evaluate exposures.
Process incoming mail and data through various systems and software.
Complete incoming and outgoing phone calls, take recorded statements when appropriate, and compose written correspondence.
Document injury-related treatment, lost wages, and other expense history thoroughly.
Perform other duties as assigned.