PIP Coverage and Qualification Adjuster
- Review and assess PIP claims to determine coverage eligibility.
- Analyze medical records, police reports, and other relevant documents to evaluate the extent of injuries and to establish proof of loss.
- Interpret insurance policies, contracts, and state regulations to determine the extent of coverage applicable to each claim.
- Communicate with claimants, medical professionals, attorneys, and other parties involved in the claim process to gather necessary information and documentation.
- Provide clear and concise explanations of coverage decisions to claimants.
- Conduct interviews with claimants to gather necessary information that supports an objective final disposition of the claims. These interviews may be conducted under oath or via phone.
- Maintain accurate and organized claim files with all pertinent information, including correspondence, medical records, and assessment reports.
- Issue payments for approved claims in accordance with company policies.
- Ensure compliance with state laws, regulations, and company policies in all claim handling activities.
- Generate and submit reports on claims activity, trends, and performance metrics.
- Identify and investigate potentially fraudulent activities related to PIP claims.
- Collaborate with the special investigation unit (SIU) when fraud is suspected.
- Provide excellent customer service by addressing inquiries, concerns, and providing timely updates to claimants.
- Prepare reports and documentation for internal purposes, regulatory compliance, and potential legal proceedings.
- Associate or bachelor’s degree preferred and/or a minimum of 3 years of related work experience, preferably with PIP claims.
- Active Adjuster’s license required
- Bilingual (English & Spanish) preferred
- Knowledge of insurance principles, policies, and procedures.
- Strong analytical, negotiation, and communication skills.
- Ability to work independently and efficiently manage a caseload.
- Proficient in Guidewire, Word, Excel, Windows-based applications and internet usage.
- Must be familiar with forms, procedures, regulations, coverages, and claims processes.
- Must be able to exercise good judgment and state opinions assertively.
- Must be able to write and speak clearly and concisely.
- Must be able to perform work effectively in a highly intense environment and handle multiple tasks and demands simultaneously.
- Must illustrate analytical skills to identify, gather, and organize information.
- Must be able to work independently in a team environment.
- 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
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