General Liability Claims Adjuster II
Intercare Holdings Insurance Services
PIP Claims Adjuster
United Automobile Insurance Company
full-time
Posted on:
Origin: • 🇺🇸 United States • Florida
Visit company websiteJob Level
Mid-LevelSenior
Tech Stack
Guidewire
About the role
- 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. Negotiate with claimants, medical providers, and legal representatives to reach fair and timely settlements. 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.
Requirements
- 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 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.
