PIP Med Pay Adjuster

First Acceptance•Marianna, FL

About The Position

The PIP Med Pay Adjuster role involves managing and processing medical payments claims. Responsibilities include reviewing correspondence, analyzing medical bills and expense claims, identifying eligible parties for coverage, and authorizing payments within company guidelines. The role requires maintaining up-to-date knowledge of claims procedures, state regulations, and policy changes. Adjusters develop settlement strategies, utilize investigation forms, and ensure compliance with Standard Operating Procedures and regulatory requirements. They also identify potential fraud indicators and collaborate with the Special Investigations Unit (SIU) when necessary. The position involves investigating state-specific Med Pay losses, evaluating exposures, processing mail and data through various systems, taking recorded statements, and composing written correspondence. A key aspect is thoroughly documenting injury-related treatment, lost wages, and other expense histories. The role also includes performing other assigned duties.

Requirements

A high school diploma or equivalency is required.
A minimum of 2 years of relevant claims, insurance, or other insurance administrative experience is required.
Must currently hold or have the ability to secure and maintain adjuster license(s) for the states handling claims.
Strong customer service skills and related behaviors are required.
Requires the ability to multitask.
Strong analytical and problem-solving skills.
Excellent interpersonal and communication skills and the ability to follow up in a timely manner.
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 is a plus.

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.
Investigate state-specific Med Pay losses and evaluate 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.