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PIP Adjuster II in Tampa, FL at The General® Insurance

Date Posted: 11/9/2018

Job Snapshot

Job Description



Overview

The General® Insurance, also known as Permanent General, is a growing company and a leading non-standard auto insurance provider.  Currently, we are seeking qualified applicants for Personal Injury Protection/No-Fault (PIP) Adjuster II.  We offer great training, a well defined career path and a fun and challenging work environment where the right candidate will learn and grow with the company.  We pride ourselves on teamwork and quality customer service.  If you do too, please check us out!

The General® offers a generous benefits package to its employees including medical, dental, vision and life insurance after one month of employment; health care and dependent care flexible spending accounts, tuition reimbursement, paid time off (vacation, sick, holidays), 401(k) participation with a matching contribution, wellness initiatives and much more!



Responsibilities

Reporting to a Claims Supervisor, this experienced PIP/No-Fault Adjuster position is responsible for investigating and resolving personal injury protection and medical payments claims in multiple states in accordance with state rules and regulations as well as company guidelines.

Essential Job Responsibilities

  • Handles complex claims in complex PIP/No-Fault venues. Uses discretion and independent decision making in claims handling to develop action plans and determine appropriate claim adjustments. Ensures compliance with state and company procedures and timeframes and maintains adequate and accurate reserves. Elevates payments, reserves and coverage determinations outside authority to the MedPIP Supervisor.
  • Examines PIP and Medical Payments claims to determine eligibility of coverage and benefits through fact gathering and claim investigations. 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 Med/PIP Supervisor as appropriate.
  • Performs other duties as assigned.



Job Requirements





Education Requirements

  • High school diploma or equivalent required.  Bachelor’s degree preferred.
  • Active Adjuster’s License preferred.

 Experience/Skills Requirements

  •  Minimum of three years of PIP/No-Fault claims adjusting experience and solid understanding of personal injury protection laws, regulations and statues required.
  • Intermediate knowledge of CPT codes, billing practices & procedures and the ability to utilize medical reference tools to research information as needed.
  • 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 basic PC and Windows skills including 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.

#CB

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