Medical Management Specialist

2 months ago

Doral, United States United Auto Insurance Full time

COMPANY OVERVIEW: Founded in 1989, United Automobile Insurance Company is an innovative and established organization looking for a PIP Medical Management Adjuster to join our team. Family-owned, UAIC, is one of the largest privately held property and casualty insurance companies in the United States. The key to our growth and success is a commitment to providing quality service to our agents and customers, by providing disciplined underwriting, and strategic claims handling. Our ongoing efforts to invest substantial resources in personnel and technology are the foundation of our promise of assuring maximum efficiency and specialized operations in the industry. We are proud that our independent agents and customers have recognized our dedication by making UAIC the market leader in every state where we conduct business. SCOPE: As a PIP Medical Management Specialist, you will play a pivotal role in processing claims within the realm of personal injury protection ensuring that injured parties receive appropriate medical care. The primary responsibility of this role is to manage and oversee the medical claims process for individuals who have been injured in automobile accidents. The goal is to ensure that injured parties receive appropriate medical treatment while adhering to the terms and regulations of the insurance policy. This position offers a

remote

work arrangement, allowing the ideal candidate to work from their preferred location within the Southeast region. DUTIES: Assess the validity of claims based on policy terms, accident details, and medical documentation. Coordinate with medical providers, policyholders, and claimants to gather necessary information for claims processing. Collaborate with medical professionals to evaluate the extent and necessity of medical treatment required for claimants' injuries. Ensure that the medical treatment being sought aligns with the injuries sustained in the accident and is reasonable and necessary. Interpret insurance policies to determine coverage limits and guidelines for medical treatment under the PIP coverage. Verify that medical treatments and services are within the coverage scope outlined in the insurance policy. Review medical bills and invoices to confirm the accuracy and reasonableness of charges. Identify and refer potential indicators to our Special Investigations Unit (SIU) for additional assistance. Accurate recognition of other relevant claims exposures. Ensure timely provision of PIP payment logs, claim details, policy data, and payment records in accordance with legal deadlines. Process payments for medical services according to the insurance policy's guidelines. Negotiate medical bills and fees with medical providers to ensure fair and reasonable pricing for services rendered. Reach settlements with medical providers and claimants, considering policy limits and coverage. Maintain detailed records of all interactions, assessments, decisions, and communications related to each claim. Uses claims systems to maintain claim information, addresses diaries, correspondences, emails, and voicemails within established time frame. Communicate with claimants and policyholders regarding the status of their claims, required documentation, and any decisions made. Address questions, concerns, and inquiries in a professional and timely manner. Stay up to date with industry regulations and changes in laws related to personal injury protection and medical claims processing. Collaborate with other members of the claims team (i.e., attorneys) to ensure accurate and effective claims management. Identify opportunities for process improvement within the claims management process to enhance efficiency and customer satisfaction. EDUCATION: Bachelor's degree in a relevant field (e.g., business or healthcare) is preferred. Adjusters license required. Bilingual preferred SKILLS & EXPERIENCE: 1-2+ years of adjusting experience within the auto insurance sector. 1-year proficiency in handling Florida Personal Injury Protection claims. Strong understanding of insurance policies, medical terminology, and billing practices. Excellent communication skills for dealing with claimants, medical professionals, and internal teams. Attention to detail and strong analytical skills for reviewing medical records and bills. Ability to work independently, make sound judgments, and handle multiple claims simultaneously. Proficient in Word, Excel, Windows-based applications, and internet usage. Knowledge of legal and regulatory requirements related to personal injury claims is beneficial. BENEFITS: 401(k) Retirement Savings Plan with employer match. Comprehensive Medical, Prescription Drug, Vision, and Dental Insurance Paid Time Off, Holidays, and Leave programs. Flexible spending accounts Basic Life Insurance and Voluntary Life/ADD Voluntary Short Term and Long-Term Disability UAIC is an Equal Opportunity Employer and is committed to the principle of equal employment opportunity for all employees. All employment decisions at UAIC are based on business needs, job requirements, and individual qualifications, without regard to race, color, religion, belief, family or parental status, or any other status protected by the laws or regulations in the locations where we operate.

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