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PIP Coverage and Qualification Adjuster
PIP Coverage and Qualification AdjusterUnited Auto Insurance • Miami, FL, US
PIP Coverage and Qualification Adjuster

PIP Coverage and Qualification Adjuster

United Auto Insurance • Miami, FL, US
3 days ago
Job type
  • Full-time
  • Quick Apply
Job description

COMPANY OVERVIEW :

  • Founded in 1989, United Automobile Insurance Company is an innovative and established organization looking for [a] Coverage and Qualification Adjuster(s) to join our team.
  • Family-owned, UAIC, is one of the largest privately held property and casualty insurance companies in the United States.
  • The key to our growth and success is a commitment to providing quality service to our agents and customers, by providing disciplined underwriting, and strategic claims handling.
  • Our ongoing efforts to invest substantial resources in personnel and technology are the foundation of our promise of assuring maximum efficiency and specialized operations in the industry.
  • We are proud that our independent agents and customers have recognized our dedication by making UAIC the market leader in every state where we conduct business.

Auto PIP Claims experience required - This is a fully remote opportunity, and the ideal candidate will have an active adjuster's license, in Florida or Texas.  SCOPE :

  • 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.

    • DUTIES :

  • 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.

    • EDUCATION :

  • 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 SKILLS & EXPERIENCE :

  • 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 UAIC participates in the E-Verify program to confirm the employment eligibility of all newly hired employees.
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    And Qualification • Miami, FL, US