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PIP Adjuster III in Miami, FL at The General® Insurance

Date Posted: 7/20/2018

Job Snapshot

Job Description



Overview

Permanent General Companies, Inc., also known as 'The General Insurance' company is a growing company and a leading non-standard auto insurance provider.  Currently, we are seeking qualified applicants for PIP Field Specialist.

 

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!

Permanent 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, PTO (Paid Time Off) and holidays. 401(k) participation with a matching contribution, wellness initiatives and much more!



Responsibilities

 Job Summary

The PIP Field Specialist is responsible for investigating and resolving personal injury protection (PIP) and medical payments claims in multiple states in accordance with state rules and regulations as well as company guidelines. This includes conducting interviews in the field with insureds, claimants and other relevant parties to the claim.   

Essential Job Responsibilities

  • Examines PIP and medical payments claims to determine eligibility of coverage and benefits through fact gathering, policy and statute analysis and field claim investigations. Field investigations may include: scene examinations and canvassing, clinic inspections, conducting in person interviews, reviewing police reports and database reports and working in association with the special investigations unit.
  • 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 management.
  • 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 verbal, in-person 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.
  • Performs other duties as assigned.


Job Requirements





Experience/Skills Requirements

  • 5+ years of PIP/no-fault claims adjusting experience
  • Prior SIU field investigation experience highly preferred

Education Requirements

  • High school diploma or equivalent required.  Bachelor’s degree strongly preferred.
  • Florida All Lines Adjuster License - 620 required.

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