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Medical Claims Adjuster
2 months ago
Why USAA?At USAA, we have an important mission: facilitating the financial security of millions of U.S. military members and their families. Not all of our employees served in our nation’s military, but we all share in the mission to give back to those who did. This hybrid role requires an individual to be in the office 3 days per week. Relocation assistance is not available for this position.
As a dedicated Injury Adjuster, you will work within defined guidelines and framework, responsible to adjust non-attorney involved soft tissue bodily injury or auto PIP/MP medical claims to include confirming coverage, determining liability, investigating, evaluating, negotiating, defending, and settling claims in compliance with state laws and regulations. Identifies and handles existing and emerging risks that stem from business activities and the job role.
Ensures risks associated with business activities are effectively identified, measured, monitored, and controlled.
Follows written risk and compliance policies, standards, and procedures for business activities.
Adjusts non-attorney involved soft tissue bodily injury claims, as well as all auto physical damage associated with those claims.
Adjusts soft tissue, moderately complex and complex 1st party PIP/MP medical claims.
Identifies, confirms, and makes coverage decisions on soft tissue claims.
Investigates loss details, determines legal liability, evaluates, negotiates, and arrives at claim settlement within appropriate authority guidelines.
Clearly documents thought process, investigation, evaluation, negotiation, and settlement decisions.
Partners and/or directs vendors and internal business partners to facilitate timely claims resolution.
Supports workload surges and/or Catastrophe Operations as needed.
1 year of injury adjusting or auto liability adjusting experience to include highly complex vehicle physical damage, such as multi-vehicle, non-owned vehicles, or total loss claims.
~ Working knowledge and understanding of the auto claims contract as well as application of case and state laws and regulations.
~ Acquisition and maintenance of insurance adjuster license within 90 days and designated number of attempts.
1yr Medical experience to include coding and billing or EMT.
~ Ongoing Professional Development with a focus on Insurance.
~ Bachelors’ Degree or higher.
~ US military experience through military service or a military spouse/domestic partner.
Compensation: USAA has an effective process for assessing market data and establishing ranges to ensure we remain competitive. Employees may be eligible for pay incentives based on overall corporate and individual performance or at the discretion of the USAA Board of Directors.
Shift premium will be addressed on an individual-basis for applicable roles that are consistently scheduled for non-core hours.
Benefits: At USAA our employees enjoy best-in-class benefits to support their physical, financial, and emotional wellness. These benefits include comprehensive medical, dental and vision plans, 401(k), pension, life insurance, parental benefits, adoption assistance, paid time off program with paid holidays plus 16 paid volunteer hours, and various wellness programs. Applications for this position are accepted on an ongoing basis, this posting will remain open until the position is filled. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, or status as a protected veteran.
