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Proactively processes Med Pay and/or Personal Injury Protection (PIP) claims while delivering superior customer service. Confirms coverage and eligibility. Investigates and establishes damages. Negotiates and/or pays assigned claims. Communicates with claim owners and other specialists to facilitate claim resolution.
Essential Job Functions
Makes timely contact with customer Explains claims process to customer Explains policy benefits to customer Confirms facts of loss Establishes expectations (future contact timing, m method of contact, etc.) Investigation Determines policy coverage applicability Determines eligibility Identifies policy and coverage issues and escalates to supervisor 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 treatment. Assesses owed benefits Reviews claims with more 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 activities to develop the knowledge, skills and abilities required to complete the job duties. Performs other duties as assigned
- Climate control office environment
Prior auto claims experience preferred
Med/PIP experience preferred
Basic critical thinking, negotiation, analytical and time management skills
Strong customer service skills.
Proficient in use of computer, internet and Microsoft Office applications (Word, Excel). General work experience with demonstrated customer service and time management skills is preferred
Maintain an active adjuster’s license in states as required.
Special Skill Requirement
Farmers is an equal opportunity employer, committed to the strength of a diverse workforce.
Job Posting: 03/18/2019