PIP Med Pay Adjuster

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.

JOB REQUIREMENTS

• A 2-year degree or higher in a related field is highly desirable; a high school diploma or equivalency is required.


• A minimum of 2 years of relevant claims, insurance, or other insurance administrative experience is required.


• Knowledge of medical and legal terminology is a plus.


• 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. 

 PHYSICAL DEMANDS:

The physical demands described here are representative of those required to perform the essential functions of this job successfully. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

While performing the duties of this job, the employee is regularly required to perform manual tasks, including using hands to finger and handle controls. Tasks may also require the ability to talk or hear. The employee will frequently sit, bend, and reach with hands and arms, and is occasionally required to stand and walk. The employee may occasionally lift and/or move up to 10 pounds. Specific vision abilities required by this job include close vision, color vision, and the ability to adjust focus. Other abilities include possessing the capacity to learn, concentrate, think, and read. Oftentimes the employee will be communicating and interacting with others while working.