Esurance PIP Senior Litigation Adjuster

Location
Work From Home
Salary
Competitive
Posted
Oct 06, 2021
Closes
Dec 05, 2021
Ref
92835538#GIJ--Allstate.1
Job Type
Not Specified
Career Level
Not Specified

The world isnt standing still, and neither is Allstate. Were moving quickly, looking across our businesses and brands and taking bold steps to better serve customers evolving needs. Thats why now is an exciting time to join our team. Youll have opportunities to take risks, challenge the status quo and shape the future for the greater good.

Youll do all this in an environment of excellence and the highest ethical standards a place where values such as integrity, inclusive diversity and accountability are paramount. We empower every employee to lead, drive change and give back where they work and live. Our people are our greatest strength, and we work as one team in service of our customers and communities.

Everything we do at Allstate is driven by a shared purpose: to protect people from lifes uncertainties so they can realize their hopes and dreams. For more than 89 years weve thrived by staying a step ahead of whatevers coming next to give customers peace of mind no matter what changes they face. We acted with conviction to advocate for seat belts, air bags and graduated driving laws. We help give survivors of domestic violence a voice through financial empowerment. Weve been an industry leader in pricing sophistication, telematics, digital photo claims and, more recently, device and identity protection. We are the Good Hands. We dont follow the trends. We set them.

Job Summary

This job is responsible for handling the medical management 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 significant. 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. At this level, the individual typically settles the most complex or specialized claims or claims involving significant dollar exposure or customers, including complex fees and extra-contractual liability, business interruption and loss of income claims, or claims in heavily regulated states, and handles litigation demands and claims in litigation or arbitration. The individual provides work guidance and direction to less senior employees and provides mentoring and coaching to the team. The individual delivers compassionate service that is fast, fair and easy to ensure customer retention. The individual works independently, prioritizes the individual's own responsibilities, and manages the individual's own workload. The individual consistently meets band level behaviors, production, quality and/or customer service goals. The individual performs a thorough investigation including; ) taking recorded statements; (3) reviewing and analyzing medical notes, bills, and conducting witness interviews. The individual reviews whether fraud can be substantiated and supports a lawsuit. At this level, the individual is expected to handle the most complex or specialized claims or claims involving significant dollar exposure or customers. From time to time, the individual may need to visit the site of home remodel, appear on behalf of Allstate at court hearings or depositions, and must build and maintain rapor with vendors needed for non-medical benefits associated with handling 1st party medical claims. The individual delivers compassionate service that is fast, fair, and easy, to ensure customer retention.

Key Responsibilities

Customer Service

  • 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
  • Manages, researches, and resolveshighly complex customer communications, concerns, conflicts or issues
  • Reviews customer satisfaction results; recommends, designs, and implements personal and business unit action plans

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)

  • Handles highly complex Tranche I claims requiring subject matter expertise and advance decision making and close monitoring of reinsurance aging
  • 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 complex or highly complex coverage and other potential coverage; and investigates coverage denial questions
  • Determines appropriate benefit and settles complex or highly complex claims, including resolution of complex usual and customary billings
  • Monitors treatment and benefit payments for excessive, unreasonable, or abusive claims
  • Handles complex or highly complex specialized 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
  • Reviews and analyzes claims in litigation or arbitration; prepares litigation, arbitration, or mediation files and case strategy; conducts research; and participates with attorneys in determining and negotiating a settlement
  • Prepares for and attends (to testify at) depositions, hearings, trials, arbitrations, or mediations
  • Reviews and approves settlements, stipulations, and legal bills
  • Has frequent customer interaction of a highly complex nature, including taking statements, responding to document requests and handling complaints
  • Must be knowledgeable about state laws and regulations
  • Control expenses through vendor management
  • May manage highly complex claims in litigation, choose defense counsel and develop or review litigation strategy

Knowledge/Skills/Abilities/Experience

  • Bachelors degree in related field preferred or equivalent experience
  • Ability to interact effectively, and coach others on interacting effectively, with internal or external customers and act with empathy
  • Applies advanced knowledge of insurance policy, coverage, and regulation
  • Applies advanced knowledge of claim processes, policies, procedures, claim systems, coverage, liability, damage estimating, and/or settlement, and adherence to applicable legal compliance standards
  • Applies advanced industry knowledge to discipline practices, including best practices, to support the business unit
  • Applies advanced knowledge of analytical procedures to reconcile, manipulate, and recognize patterns of data
  • Applies advanced knowledge of problem solving and preparation of complex reports for analysis
  • Applies advanced ability to leverage learned technical skills in support of team objectives
  • Applies advanced negotiation and/or arbitration skills
  • Applies advanced conflict management and problem resolution skills in managing internal and external customer relationships
  • Applies advanced problem solving skills to continuously improve business outcomes
  • Ability to assist leadership in achieving business unit objectives
  • Applies advanced knowledge of training facilitation and coaching skills
  • Ability to investigate, evaluate, negotiate, and settle complex and occasionally highly complex claims
  • Provides advanced individual decision making within authority limits
  • May work within complex and occasionally highly complex assignments requiring specialized knowledge in breadth and/or depth in area of expertise
  • 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.For a full description of Allstates benefits, visit allstate.jobs/benefits/

Learn more about life at Allstate. Connect with us on Twitter, Facebook, Instagram and LinkedIn or watch a video.

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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