Encompass PIP/Medpay Analyst
- Career Level
- Not Specified
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Encompass Insurance has an exciting opportunity for a Personal Injury Projection/Medical Payments Adjuster in Bridgewater, NJ!
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 peoples 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
As a Personal Injury Projection/Medical Payments Adjuster you will be responsible for handling the medical portion of auto accident claims in which our Encompass customers are involved for the insured or other injured parties found to be eligible under a personal injury protection benefit where the policy limits or exposure to the company is limited and occasionally when the policy limits or exposure to the company is moderate. On moderately complex claims you will determine applicable coverage and assess medical claims, evaluate medical bills, and initiate potential fraud investigations as warranted. You will explain coverages, negotiate and settle claims, and follow up with customers on continuing treatments while delivering compassionate service that is fast, fair, and easy, to ensure customer retention.
Specific responsibilities include:
- Makes and maintains a connection with the customer by understanding and meeting their needs; serves the customer with empathy; and follows up to ensure that customer needs have been met
- Researches and responds to moderately complex customer communications, concerns, conflicts or issues
File Documentation and Reporting
- Summarizes documents and enters into claim system notes
- 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
- Conducts first party file processing/fact gathering, including interviewing claimant, witnesses, medical providers, etc.
- Evaluates medical records and treatment plan of claimant and determines if continued treatment is reasonable
- Sets up IME and reviews results
- Investigates, reviews, and accepts or rejects moderately complex coverage and other potential coverage; and investigates coverage denial questions
- Determines appropriate benefit and negotiates and settles moderately complex claims, including resolution of moderately complex usual and customary billings
- Monitors treatment and benefit payments for excessive, unreasonable, or abusive claims
- Handles specialized claims
- Medical coding certificate through professional coding program such as AAPC ( American Academy of Professional Coders ) or Ahima (American Health Information Management Association) is required
- Must have knowledge of medical reimbursement and adjustments such as NCCI and MUE edits.
- Prior medical claim handling preferred
- High School Diploma/General Education Diploma is required, Bachelors Degree preferred
- Excellent customer service skills and a passion to help others
- Ability to be a self-starter and work independently but also in a team environment
- Excellent time management skills
- Critical thinking with the ability to make decisions with limited supervision
- Strong organizational skills
- Excellent oral, phone and written communication skills
- Strong computer, typing and grammar skills
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 thats 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, youll 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.
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