- Career Level
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Allstate Insurance Company has an exceptional career opportunity for an Experienced Inside PIP Adjuster in Farmington Hills, MI!
About the Team
The Claims Department is here to restore peoples' lives after the unexpected has happened. We work to deliver compassionate service that is fast, fair and easy. Putting our customers first to resolve their claim and taking the stress out of the situation is our goal.
This is your chance to help make a meaningful difference in people's lives. Join the thousands of people who work in the claims industry in highly stimulating work that will require you to assimilate data, evaluate facts and negotiate solutions to complex problems. Every day presents different learning and growth opportunities. You will gain a broad range of professional skills that will be equally applicable and highly valuable no matter where your career takes you.
About the Position
Under limited supervision, this job is responsible for handling the medical portion of auto accident claims for the insured or other injured parties found to be eligible under a personal injury protection and/or medical payment benefits where the policy limits or exposure to the company is moderate. This individual determines coverage and assesses medical claims, evaluates medical bills, and initiates or reviews potential fraud investigations as warranted. The individual provides work guidance and direction to less senior employees.
Specific responsibilities include
• Researches and responds to moderate and occasionally complex customer communications, concerns, conflicts or issues
• Reviews customer satisfaction results; works independently to create personal action plans
File Documentation and Reporting
• Documents a claim file with notes, evaluations and decision making process
• Processes medical bills and recognizes medical management opportunities
Medical Management (1st Party)
• Assesses medical/physical condition and prior injuries of claimant, and obtains and analyzes medical bills, wage loss reviews, home service or attendant care, mileage payments, and other related claims to determine reasonableness of charges and relation of injuries to accident, and to ensure compliance with fee schedules, and detect duplicate billing
• Evaluates medical records and treatment plan of claimant and determines if continued treatment is reasonable
• Determines appropriate benefit and negotiates and settles moderately complex and occasionally complex claims, including resolution of moderately complex and occasionally complex usual and customary billings
• Monitors treatment and benefit payments for excessive, unreasonable, or abusive claims
• Reviews and responds to pre-suit demand letters; analyzes claim and demand, and recommends whether settlement is warranted or claim should be referred to legal counsel
• May prepare for and attend (to testify at) depositions, hearings, trials, arbitrations, or mediations
Other Projects and Responsibilities
• Reviews subpoenas and other documents related to moderate and occasionally complex litigation demands and prepares response
• May serve as a subrogation or arbitration panelist
• May serve as an agent advocate
• May prepare and negotiate moderate and occasionally complex subrogation issues or arbitrations
• Bachelors degree in related field preferred or equivalent experience
• 3 - 5 years of prior claims handling experience strongly preferred
• Ability to investigate, evaluate, negotiate and settle moderate and occasionally complex claims
• Excellent written and verbal communication skills with a passion for helping others.
• Strong organizational and computer skills.
• Persistence and the ability to work through and solve problems.
• Bilingual candidates are strongly encouraged to apply
• Has and maintains all appropriate licenses and registrations for the role per state requirements
The candidate(s) offered this position will be required to submit to a background investigation, which includes a drug screen.
Good Work. Good Life. Good Hands®.
As a Fortune 100 company and industry leader, we provide a competitive salary – but that's just the beginning. Our Total Rewards package also offers benefits like tuition assistance, medical and dental insurance, as well as a robust pension and 401(k). Plus, you'll have access to a wide variety of programs to help you balance your work and personal life -- including a generous paid time off policy.
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Allstate generally does not sponsor individuals for employment-based visas for this position.
Effective July 1, 2014, under Indiana House Enrolled Act (HEA) 1242, it is against public policy of the State of Indiana and a discriminatory practice for an employer to discriminate against a prospective employee on the basis of status as a veteran by refusing to employ an applicant on the basis that they are a veteran of the armed forces of the United States, a member of the Indiana National Guard or a member of a reserve component.
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It is the policy of Allstate to employ the best qualified individuals available for all jobs without regard to race, color, religion, sex, age, national origin, sexual orientation, gender identity/gender expression, disability, and citizenship status as a veteran with a disability or veteran of the Vietnam Era.