PIP Adjuster Medical Management

United Auto Insurance • Miami, FL

1d • Remote

About The Position

As a PIP Medical Management Adjuster, you will play a pivotal role in processing claims within the realm of Personal Injury Protection ensuring that injured parties receive appropriate medical care. The primary responsibility of this role is to manage and oversee the medical claims process for individuals who have been injured in automobile accidents. The goal is to ensure that injured parties receive appropriate medical treatment while adhering to the terms and regulations of the insurance policy.

Requirements

• Over 2 years of adjusting experience within the auto insurance sector.
• 1-year proficiency in handling Florida Personal Injury Protection claims.
• Strong understanding of insurance policies, medical terminology, and billing practices.
• Excellent communication skills for dealing with claimants, medical professionals, and internal teams.
• Attention to detail and strong analytical skills for reviewing medical records and bills.
• Ability to work independently, make sound judgments, and handle multiple claims simultaneously.
• Knowledge of legal and regulatory requirements related to personal injury claims is beneficial.
• Adjusters license required.

Nice To Haves

• Bachelor's degree in a relevant field (e.g., business or healthcare) is preferred.
• Bilingual preferred

Responsibilities

• Assess the validity of claims based on policy terms, accident details, and medical documentation.
• Coordinate with medical providers, policyholders, and claimants to gather necessary information for claims processing.
• Collaborate with medical professionals to evaluate the extent and necessity of medical treatment required for claimants' injuries.
• Ensure that the medical treatment being sought aligns with the injuries sustained in the accident and is reasonable and necessary.
• Interpret insurance policies to determine coverage limits and guidelines for medical treatment under the PIP coverage.
• Verify that medical treatments and services are within the coverage scope outlined in the insurance policy.
• Review medical bills and invoices to confirm the accuracy and reasonableness of charges.
• Detect and forward potential red flags to our Special Investigations Unit (SIU) for further support.
• Accurate recognition of other relevant claims exposures.
• Ensure timely provision of PIP payment logs, claim details, policy data, and payment records in accordance with legal deadlines.
• Process payments for medical services according to the insurance policy's guidelines.
• Negotiate medical bills and fees with medical providers to ensure fair and reasonable pricing for services rendered.
• Reach settlements with medical providers, considering policy limits and coverage.
• Maintain detailed records of all interactions, assessments, decisions, and communications related to each claim.
• Prepare reports and documentation for internal purposes, regulatory compliance, and potential legal proceedings.
• Communicate with claimants and policyholders regarding the status of their claims, required documentation, and any decisions made.
• Address questions, concerns, and inquiries in a professional and timely manner.
• Stay up to date with industry regulations and changes in laws related to personal injury protection and medical claims processing.
• Collaborate with other members of the claims team (i.e., attorneys) to ensure accurate and effective claims management.

Benefits

• 401(k) Retirement Savings Plan with employer match.
• Comprehensive Medical, Prescription Drug, Vision, and Dental Insurance
• Paid Time Off, Holidays, and Leave programs.
• Flexible spending accounts
• Basic Life Insurance and Voluntary Life/ADD
• Short Term and Long-Term Disability
• UAIC participates in the E-Verify program to confirm the employment eligibility of all newly hired employees. For more information about E-Verify, please visit https://www.e-verify.gov/.
• UAIC is an Equal Opportunity Employer and is committed to the principle of equal employment opportunity for all employees. All employment decisions at UAIC are based on business needs, job requirements, and individual qualifications, without regard to race, color, religion, belief, family or parental status, or any other status protected by the laws or regulations in the locations where we operate.

What This Job Offers

• Job Type: Full-time
• Career Level: Mid Level
• Number of Employees: 501-1,000 employees