Med/PIP Specialist II - Northeast Zone
We are Farmers!
We are… more than just your favorite commercials. We are a passionate, award winning, equal opportunity employer, committed to the strength of a diverse workforce. We are dedicated to supporting the well-being of our people through our extensive suite of benefits, as well as the well-being of the communities we serve through employee volunteer programs and nonprofit partnerships. Helping others in their time of need isn’t just our business – it’s our culture! We are Farmers!
Do you thrive in a high-volume, fast-paced environment? Do you enjoy the challenge of a position where no two days are alike? We are looking for positive, high-energy professionals who are not just looking for a job, but a meaningful career!
Job Summary
Essential Job Functions
- Customer Relationship Makes timely contact with customer
- Explains claims process to customer Explains policy benefits to customer
- Confirms facts of loss
- Establishes expectations (future contact timing, method of contact, etc.)
- Investigation
- Determines policy coverage applicability
- Determines eligibility Identifies and handles policy or coverage issues
- Secures supporting documents such as, medical records, bills, and wage loss verification
- Identifies subrogation opportunities and refers claim to Subrogation department to follow-up
- Obtain additional information from all parties as needed to confirm proximate cause of loss and mechanism of injury
- Recognizes potential fraudulent claims and escalates to supervisor for review Communicates with underwriting on policy issues
- Evaluation Reviews and analyzes medical bills, records, wage loss documentation, and other information
- Reviews all investigation materials for causal relationship between the claim incident and the injuries reported Utilizes available resources and tools to ensure accuracy of evaluation of medical claim.
- Assesses owed benefits
- Reviews claims with complex investigation questions or issues with supervisor Claim Resolution
- Identifies need for medical intervention, such as an Independent Medical Exam or peer review, and initiates the process
- Recognizes and resolves disputes over covered benefits, medical bill amounts, etc. with customer or provider as appropriate
- Negotiates and settles claims based on the merits of the claim File Management
- Proactively manages claim inventory to ensure all assigned claims are handled to completion in a timely fashion, including follow-up contacts, bill payment, etc. compliant with regulatory requirements
- Utilizes claim system and other technologies to document file activities, strategy, and communication with customers, attorneys and medical providers
- Ensures that all correspondence to customers is appropriate and professional
- Discusses status of injuries and medical treatment plans with customers and medical providers Identifies Medicare eligibility and provides appropriate notification to customer as required
- Responds to customer and provider inquiries and resolves complaints promptly
- Completes assigned training and mentors Level I Med/PIP Specialists
- Performs other duties as assigned
Physical Environment
Education Requirements
Experience Requirements
Job Location(s): US - MA - Remote, US - NY - Remote, US - NJ - Remote, US - NH - Remote
Want to learn more about our culture & opportunities? Check out farmers.com/careers and be sure to follow us on Instagram and LinkedIn!