Inside Medical Payment Adjuster
- Career Level
- Not Specified
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Allstate Insurance Company has an exceptional career opportunity for an Insdie Medical Payment Adjuster located in Northwest Houston, TX.
Medical Payment Adjuster is responsible for handling the medical portion of auto accident claims for the insured or other injured parties found to be eligible under personal injury protection and/or medical payment benefits where the policy limits or exposure to the company is limited. This individual determines coverage and assesses medical claims, evaluates medical bills and initiates or reviews potential fraud investigations as warranted. The individual explains coverage, negotiates and settles claims and follows up with the customer on continuing treatments while gaining experience in delivering compassionate service that is fast, fair, and easy, to ensure customer retention. At this level, the individual typically settles minor or smaller claims, such as claims in less regulated states (or on some occassions more complex claims with guidance as needed). The individual is gaining experience in delivering compassionate service that is fast, fair, and easy, to ensure customer retention. The individual is capable of working independently, prioritizing the individual's own responsibilities, and managing the individual's own workload
- 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
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 in determining 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
- Investigates, reviews and accepts or rejects coverage and other potential coverage
- Determines appropriate benefit and settles basic claims, including resolution of basic usual and customary billings
- Monitors treatment and benefit payments for excessive, unreasonable, or abusive claims
Starting Salary: $42,200
Must be available to work a scheduled shift between the hours of 7:00am - 7:30pm CST Monday - Friday and Saturdays from 8:00am - 4:30pm.
- Bachelors degree preferred and/or Medical Coding Certification
- At least one year of customer service experience in an office environment
- Experienced with handling heavy call volume
- Interact effectively with internal or external customers and act with empathy
- Ability to investigate, evaluate, negotiate and settle basic claims
- Knowledge of claim processes, policies, procedures, claim systems, coverage, liability, damage estimating, and/or settlement, and adherence to applicable legal compliance standards
- Ability to apply industry knowledge to discipline practices, including best practices, to support the business unit
- Ability to leverage learned technical skills in support of team objectives
- Conflict management and problem resolution skills in managing internal and external customer relationships
- Provides individual decision making within authority limits
- 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 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.
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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