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MedPIP Adjuster I in Phoenix, AZ at The General® Insurance

Date Posted: 4/18/2019

Job Snapshot

Job Description


The General is seeking a MedPIP Adjuster I to join our company.


This position is responsible for investigating and resolving low-complexity first party medical payments and/or PIP (personal injury protections/no-fault) medical claims in multiple states in accordance with state rules and regulations as well as company guidelines.

Handles low-complexity medical payments and or PIP/No-Fault claims. Works closely with management and/or senior level adjusters to determine appropriate claim adjustments and resolution. Ensures compliance with state and company procedures and timeframes and maintains adequate and accurate reserves. Elevates payments, reserves and coverage determinations outside authority to management.

•         Examines PIP and medical payments claims to determine eligibility of coverage and benefits through fact gathering and claim investigations and elevates recommendations to management. Investigations may include: reviewing police reports, taking recorded statements, analyzing and interpreting policies, state regulations and statutes and referring files to the special investigations unit.

•         Provides exceptional customer service by assisting customers throughout the 1st party medical claims process. This includes but is not limited to: explaining the applicable benefits, eligibility, required forms and procedures, providing claim status updates and information through both verbal and written communications and issuing timely and accurate reimbursement of medical, wage loss, and other benefits available under the policy as appropriate.

•         Responsible for obtaining, analyzing, adjusting and processing timely and accurate payments on medical bills within prescribed authority. Bill analysis will include: reviewing medical records and codes for reasonableness, relatedness and duplicate charges, reviewing compliance with applicable fee schedules, ensuring accuracy in application of applicable co-pays and deductibles, coordinating and reviewing results of independent medical examinations and peer reviews and making claim handling recommendations as appropriate.

•         Responsible for determination and issuance of timely and appropriate reimbursement for lost wages by analyzing disability medical records, employment/wage information and other pertinent documentation. Additionally, reviews claims made for other reimbursable expenses and determines proper payment.

•         Responds promptly to written and verbal inquiries from injured parties, medical providers, and attorneys, including by not limited to: PIP payment logs, claim information, policy information and payment information.

•         Responsible for properly and timely reserving the claim file, issues payments to medical providers, customers and vendors in accordance with specified state and company timeframes and within authority. Requests authority from management as appropriate.

•         Based on departmental need, may be responsible for handling claims files which have been identified as fast track.  Handling of these claim files will require aggressive attempts to obtain the needed customer contacts and medical bills in order expedite the resolution of the claim file. Additional responsibilities while assigned to the fast track team include assisting the claim assistants with exporting medical bills to our bill review vendor, investigating claim files that appear to have been reported under a policy that is no longer in force and drafting denials for medical bills received on files where it has been determined that first party medical coverage is not available.

•         Other duties as assigned

Job Requirements

  • Excellent customer service skills including both verbal and written communication
  • Ability to multi-task, manage time effectively and has strong organizational skills
  • Detail oriented and ability to draw independent conclusions
  • Must know how to type and be proficient with Microsoft Office software
  • Ability to perform basic math calculations (addition, subtraction, multiplication, and division) as well as the calculation of averages and percentages
  • Bi-lingual a plus

Education Requirements

  • High school diploma/GED required
  • Bachelor’s Degree preferred
  • Entry-level position; interest in learning about physical injuries, medical terminology, medical treatment protocols, and the wage loss claims process
  • State Licensing may be required.



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