Farmers Insurance Senior Med/PIP Specialist - East Meadow, NY in East Meadow, New York
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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 and collaborates, either in an owner or specialist role, with claim owners and other specialists to facilitate claim resolution.
This position is located in East Meadow, NY and selected applicant must reside in the commutable distance. Prior experience with Med/PIP insurance claims is desired.
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, method of contact, etc.)
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
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 complex investigation questions or issues with supervisor
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
- May assist Branch Legal Office with litigation, arbitration and mediation
- May handle litigated claims 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
- Backstops peers and/or supervisors as needed Mentors and coaches Med/PIP Specialists (Level I and II)
- Participates in special projects or initiatives
Performs other duties as assigned
High School diploma or equivalent required.
- Bachelor's degree preferred.
Completion of, or actively pursuing a major insurance designation, or actively pursuing insurance related courses.
Advanced critical thinking, negotiation, analytical and time management skills. Strong customer service skills.
- Proficient in use of computer, internet and Microsoft Office applications (Word, Excel).
- Demonstrates advanced knowledge of medical and coding terminology.
- Two (2) years Med/PIP Specialist Level II experience or successful demonstration of technical proficiency handling Med/PIP claims.
- Successful completion of on the job training requirements.
Maintain an active adjuster’s license in states as required.
Farmers is an equal opportunity employer, committed to the strength of a diverse workforce.
Organization: *Farmers Insurance
Title: Senior Med/PIP Specialist - East Meadow, NY
Location: New York-East Meadow
Requisition ID: 19000562