[Hiring] PIP Coverage and Qualification Adjuster @United Auto Insurance

Role Description

As a Coverage and Qualification Adjuster, you will be responsible for reviewing and processing Personal Injury Protection claims, ensuring compliance with company policies and state regulations. This role involves assessing the validity of claims, determining coverage limits, and facilitating timely and accurate settlements.

• 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.

Qualifications

• 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.

Requirements

• 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.

Benefits

• 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.